Provider Demographics
NPI:1558649392
Name:TALAVERA, DESTINEE ALYANA
Entity Type:Individual
Prefix:MRS
First Name:DESTINEE
Middle Name:ALYANA
Last Name:TALAVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DESTINEE
Other - Middle Name:ALYANA
Other - Last Name:MCCRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:718 CLOPPER RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1731 BUNKER HILL RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3026
Practice Address - Country:US
Practice Address - Phone:202-635-5756
Practice Address - Fax:202-461-3687
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000609225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist