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Individual

LATASHA NICOLE MALLARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
150 COTTAGE LN, CARROLLTON, GA 30117-6200
(770) 830-8857
Mailing address
150 COTTAGE LN, CARROLLTON, GA 30117-6200
(770) 830-8857

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA002989
GA

Other

Enumeration date
10/26/2023
Last updated
10/26/2023
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