Provider Demographics
NPI:1730066655
Name:GRAVES, YATIA LAQUE
Entity type:Individual
Prefix:MS
First Name:YATIA
Middle Name:LAQUE
Last Name:GRAVES
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 1:4399 PORTSMOUTH BLVD APT 2A
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2553
Mailing Address - Country:US
Mailing Address - Phone:757-818-2236
Mailing Address - Fax:
Practice Address - Street 1:4399 PORTSMOUTH BLVD APT 2A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2553
Practice Address - Country:US
Practice Address - Phone:757-818-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health