MEDICARE: MRS. LATARSHA TALAINE GREENWOOD GILES M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	38183	TX

General Provider Information

NPI Number	:	1669951422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATARSHA TALAINE GREENWOOD GILES M.ED.

Provider Business Mailing Address
First Line	:	3419 SPARTA DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6760
Country	:	US
Telephone Number	:	281-433-2977
Fax Number	:

Provider Business Practice Location Address
First Line	:	3419 SPARTA DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6760
Country	:	US
Telephone Number	:	281-433-2977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2018
Last Update Date	:	08/11/2018

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