Individual
JEWELLYN DAVIN LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2625 ANITA DR., GARLAND, TX 75041
(972) 490-9055
(972) 265-0392
Mailing address
320 CUSTER ROAD, RICHARDSON, TX 75080
(972) 490-9055
(972) 265-0392
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
111120
TX
Other
Enumeration date
08/30/2011
Last updated
08/30/2011
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