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General NPI Number Information
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NPI Number | 1578909453
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Entity Type | Individual
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Provider Name | LAUREN S. LATHAM
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Gender | Female
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 4800 FILLMORE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5070
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Country | US
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Telephone | 703-578-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 218 CAMERON STATION BLVD
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City | ALEXANDRIA
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State | VA
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Zip | 22304-7774
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Country | US
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Telephone | 703-231-8950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 104168
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119007823
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License Number State | VA
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