Provider Demographics
NPI:1164605788
Name:LATSA, ELIZABETH ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:LATSA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N ORLANDO AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3606
Mailing Address - Country:US
Mailing Address - Phone:407-622-7177
Mailing Address - Fax:
Practice Address - Street 1:140 N ORLANDO AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3606
Practice Address - Country:US
Practice Address - Phone:407-622-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist