MEDICARE: DAVID A LATTIMORE

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	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician	A61468992	VA

General Provider Information

NPI Number	:	1891293411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A LATTIMORE

Provider Business Mailing Address
First Line	:	2211 VICTORIA BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-2933
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2847 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4512
Country	:	US
Telephone Number	:	703-870-3880
Fax Number	:

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

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	01/29/2018

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Directions to “ DAVID A LATTIMORE ” Practice Location

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