MEDICARE: LAKISHA LATONYA MAPP MS, OTR/L

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	225X00000X	Occupational Therapist	OT005878	GA

General Provider Information

NPI Number	:	1851741334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKISHA LATONYA MAPP MS, OTR/L

Provider Business Mailing Address
First Line	:	5408 PARK CIR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-2260
Country	:	US
Telephone Number	:	404-234-7550
Fax Number	:

Provider Business Practice Location Address
First Line	:	5408 PARK CIR
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-2260
Country	:	US
Telephone Number	:	404-234-7550
Fax Number	:

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

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/21/2016

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