Individual
LATISHA STOVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 N GRAYSTONE LN, BUSHLAND, TX 79124-1539
(806) 787-8610
Mailing address
PO BOX 399, BUSHLAND, TX 79012-0399
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
111527
TX
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
Other
Enumeration date
01/12/2021
Last updated
01/21/2021
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