Healthcare Provider Details

I. General information

NPI: 1942031943
Provider Name (Legal Business Name): LATOYA QUINETT COACHMAN RT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD FL 5
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

1913 BRIDGECREST XING 1913
SAINT CHARLES MO
63303-4814
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-6500
  • Fax:
Mailing address:
  • Phone: 229-221-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2023014067
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: