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NPI Code Detail

MEDICARE: TATUM LAVOISE OTR/L

MEDICARE: TATUM LAVOISE 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
1225X00000XOccupational Therapist24482CA

General Provider Information

NPI Number : 1962108266
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATUM LAVOISE OTR/L
Provider Business Mailing Address
First Line : 3814 CHEROKEE AVE APT 8
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104-3154
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4010 MORENA BLVD STE 103
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-4547
Country : US
Telephone Number : 661-433-1695
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2023
Last Update Date : 07/31/2025

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Directions to “ TATUM LAVOISE OTR/L” Practice Location

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