Provider Demographics
NPI:1730565706
Name:TALTON, KAILANI BALAGEO (OTR/L)
Entity type:Individual
Prefix:
First Name:KAILANI
Middle Name:BALAGEO
Last Name:TALTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GAY
Other - Middle Name:BALAGEO
Other - Last Name:TALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569-0927
Mailing Address - Country:US
Mailing Address - Phone:919-432-8789
Mailing Address - Fax:
Practice Address - Street 1:141 FAISON RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569-7422
Practice Address - Country:US
Practice Address - Phone:919-432-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist