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General NPI Number Information
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NPI Number | 1962380337
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Entity Type | Individual
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Provider Name | MR. LATRELL RASHOD PETERSON SR.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 6615 HIGHLAND GREENS DR APT 215G
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City | WEST CHESTER
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State | OH
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Zip | 45069-7664
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Country | US
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Telephone | 734-304-3084
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Fax |
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Provider Business Mailing Address
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Address Line | 6615 HIGHLAND GREENS DR APT 215G
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City | WEST CHESTER
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State | OH
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Zip | 45069-7664
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Country | US
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Telephone |
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | VC597561
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | VC597561
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | VC597561
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | VC597561
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License Number State | OH
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