Provider Demographics
NPI:1578784799
Name:HARVEY, LATOYA S (OTRL)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:S
Last Name:HARVEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2145
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-2145
Mailing Address - Country:US
Mailing Address - Phone:912-537-3066
Mailing Address - Fax:912-538-9812
Practice Address - Street 1:206 QUEEN ST STE 10
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4263
Practice Address - Country:US
Practice Address - Phone:912-537-3066
Practice Address - Fax:912-538-9812
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003870225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics