Healthcare Provider Details

I. General information

NPI: 1225963069
Provider Name (Legal Business Name): LATEASA RENEE SPEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 SALEM AVE
DAYTON OH
45406-4941
US

IV. Provider business mailing address

220 LANDMARK CT APT D
FAIRBORN OH
45324-2758
US

V. Phone/Fax

Practice location:
  • Phone: 937-993-9594
  • Fax:
Mailing address:
  • Phone: 937-993-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: