Provider Demographics
NPI:1790004323
Name:TALLEY, WILHEMINA JUDKINS (THERAPISTS)
Entity Type:Individual
Prefix:
First Name:WILHEMINA
Middle Name:JUDKINS
Last Name:TALLEY
Suffix:
Gender:F
Credentials:THERAPISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-8743
Mailing Address - Country:US
Mailing Address - Phone:252-425-8543
Mailing Address - Fax:
Practice Address - Street 1:501 HAMPTON LN
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-8743
Practice Address - Country:US
Practice Address - Phone:252-425-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09911173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist