Provider Demographics
NPI:1730647306
Name:TALLEY, KELLY (COTA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2412 SW RIVER TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-7811
Mailing Address - Country:US
Mailing Address - Phone:816-446-9018
Mailing Address - Fax:816-554-1379
Practice Address - Street 1:2706 NE INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2323
Practice Address - Country:US
Practice Address - Phone:816-446-9018
Practice Address - Fax:816-554-1379
Is Sole Proprietor?:No
Enumeration Date:2019-03-03
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019005336224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant