Provider Demographics
NPI:1447922463
Name:THOMAS, LATOYA (MS OTRL)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 LUZON LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1431
Mailing Address - Country:US
Mailing Address - Phone:616-634-8072
Mailing Address - Fax:
Practice Address - Street 1:8515 COSTA VERDE BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1130
Practice Address - Country:US
Practice Address - Phone:888-674-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22805225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist