Provider Demographics
NPI:1508246893
Name:CHILTON, LATASHA
Entity Type:Individual
Prefix:MS
First Name:LATASHA
Middle Name:
Last Name:CHILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N RANCHO DR
Mailing Address - Street 2:113
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3155
Mailing Address - Country:US
Mailing Address - Phone:702-998-0551
Mailing Address - Fax:702-998-0552
Practice Address - Street 1:3620 N RANCHO DR
Practice Address - Street 2:113
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3155
Practice Address - Country:US
Practice Address - Phone:702-998-0551
Practice Address - Fax:702-998-0552
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner