Individual
MS. MARIE LATACZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12219 LEGACY BRIGHT ST, RIVERVIEW, FL 33578
(732) 966-6632
Mailing address
12219 LEGACY BRIGHT ST, RIVERVIEW, FL 33578
(732) 966-6632
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
10591
FL
Other
Enumeration date
05/22/2018
Last updated
05/22/2018
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