Provider Demographics
NPI:1265650733
Name:LAFITTE, CORRINE CAMILLA (LOTA)
Entity Type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:CAMILLA
Last Name:LAFITTE
Suffix:
Gender:F
Credentials:LOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12407 FERN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2214
Mailing Address - Country:US
Mailing Address - Phone:281-500-1380
Mailing Address - Fax:
Practice Address - Street 1:12407 FERN MEADOW DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2214
Practice Address - Country:US
Practice Address - Phone:281-500-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209453224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant