Healthcare Provider Details

I. General information

NPI: 1831495092
Provider Name (Legal Business Name): RAPHAELE JACQUELINE LATAILLADE MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAPHAELE LATAILLADE MS,OTR/L

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 GRIFFON LANE APT 116
VERO BEACH FL
32966
US

IV. Provider business mailing address

7855 GRIFFON LANE APT 116
VERO BEACH FL
32966
US

V. Phone/Fax

Practice location:
  • Phone: 954-593-5884
  • Fax:
Mailing address:
  • Phone: 954-593-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT10833
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: