MEDICARE: LETICIA MICHELLE CANTON MA

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	343900000X	Non-emergency Medical Transport (VAN)	18331950	TX
2	347C00000X	Private Vehicle	18331950	TX

General Provider Information

NPI Number	:	1992179139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETICIA MICHELLE CANTON MA

Provider Business Mailing Address
First Line	:	300 KIRKSTALL DR APT 1210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-6431
Country	:	US
Telephone Number	:	832-882-5937
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 KIRKSTALL DR APT 1210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-6431
Country	:	US
Telephone Number	:	832-882-5937
Fax Number	:

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

Provider Enumeration Date	:	11/27/2015
Last Update Date	:	11/27/2015

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Directions to “ LETICIA MICHELLE CANTON MA” Practice Location

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