Healthcare Provider Details

I. General information

NPI: 1649188459
Provider Name (Legal Business Name): LATISHA N PAGE OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKKI PAGE OTD, OTR/L

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 PINE DR
LAUREL MS
39443-7205
US

IV. Provider business mailing address

138 PINE DR
LAUREL MS
39443-7205
US

V. Phone/Fax

Practice location:
  • Phone: 601-319-2340
  • Fax:
Mailing address:
  • Phone:
  • Fax: 601-319-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2163
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: