Healthcare Provider Details

I. General information

NPI: 1689732539
Provider Name (Legal Business Name): SUSAN M LATSHAW OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BEACON PKWY W
BIRMINGHAM AL
35209-3124
US

IV. Provider business mailing address

4433 MELISSA WAY
BIRMINGHAM AL
35243-5340
US

V. Phone/Fax

Practice location:
  • Phone: 205-945-4859
  • Fax: 205-945-8605
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2495
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: