Provider Demographics
NPI:1861034654
Name:TALLEY, VICTORIA PAIGE (OTR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:PAIGE
Last Name:TALLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 S WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7929
Mailing Address - Country:US
Mailing Address - Phone:312-342-8332
Mailing Address - Fax:
Practice Address - Street 1:1532 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1588
Practice Address - Country:US
Practice Address - Phone:219-515-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist