Provider Demographics
NPI:1235483397
Name:TALLEY, ERIN (LMT,CMLDT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LMT,CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GLEN OAK CT E
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3052
Mailing Address - Country:US
Mailing Address - Phone:615-403-6755
Mailing Address - Fax:
Practice Address - Street 1:110 GLEN OAK CT E
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3052
Practice Address - Country:US
Practice Address - Phone:615-403-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist