Provider Demographics
NPI:1063173359
Name:HALVORSON, TALLEY
Entity type:Individual
Prefix:
First Name:TALLEY
Middle Name:
Last Name:HALVORSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DAVID CT
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80651-7582
Mailing Address - Country:US
Mailing Address - Phone:715-382-3067
Mailing Address - Fax:
Practice Address - Street 1:627 25 1/2 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-6401
Practice Address - Country:US
Practice Address - Phone:970-242-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007152225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand