Provider Demographics
NPI:1225722283
Name:TALLEY, PHYLICIA
Entity Type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27720 JEFFERSON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2609
Mailing Address - Country:US
Mailing Address - Phone:619-807-4336
Mailing Address - Fax:
Practice Address - Street 1:1582 W SAN MARCOS BLVD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:951-587-6973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant