Individual
LATASHA BROWN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
606 MAYFERN TRCE, FAIRBURN, GA 30213-6004
(678) 361-3238
Mailing address
606 MAYFERN TRCE, FAIRBURN, GA 30213-6004
(678) 361-3238
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
000611
GA
Other
Enumeration date
05/08/2013
Last updated
05/08/2013
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