Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | TA2597 | MS |
NPI | 1023661824 |
---|---|
Provider Name | Ms. Latoya Lanette Trunell |
First Address | Jackson, MS 39206 |
Second Address | Jackson, MS 39206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2019 |
Last Update Date | 20/07/2019 |