Provider Demographics
NPI:1811466642
Name:DORSEY, TALISA S (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:TALISA
Middle Name:S
Last Name:DORSEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 GENTRY CIRCLE.
Mailing Address - Street 2:APT 301
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012
Mailing Address - Country:US
Mailing Address - Phone:919-454-6265
Mailing Address - Fax:
Practice Address - Street 1:190 MORAVIAN WAY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3216
Practice Address - Country:US
Practice Address - Phone:919-454-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility