Individual
LATISHA RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1315 RENSHAW RD APT B2, CHESTER, PA 19013-1569
(717) 208-3799
Mailing address
1315 RENSHAW RD APT B2, CHESTER, PA 19013-1569
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP007894
PA
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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