Provider Demographics
NPI:1215058631
Name:TALBOT, KARA LYN (PT)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:LYN
Last Name:TALBOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:763-561-4045
Mailing Address - Fax:763-561-8690
Practice Address - Street 1:5740 BROOKLYN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3062
Practice Address - Country:US
Practice Address - Phone:763-561-4045
Practice Address - Fax:763-561-8690
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist