Provider Demographics
NPI:1437451010
Name:KIRBY, LATIA SHANAE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LATIA
Middle Name:SHANAE
Last Name:KIRBY
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 1:1413 COLONY RD.
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745
Mailing Address - Country:US
Mailing Address - Phone:301-751-3250
Mailing Address - Fax:
Practice Address - Street 1:6551 PARK OF COMMERCE BLVD.
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487
Practice Address - Country:US
Practice Address - Phone:800-530-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06432225X00000X
TX113784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist