Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5201001502 | MI |
NPI | 1063904712 |
---|---|
Provider Name | Celest Latcha |
First Address | Detroit, MI 48201-2196 |
Second Address | Detroit, MI 48201-2196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2018 |
Last Update Date | 30/05/2018 |