Provider Demographics
NPI:1851741334
Name:MAPP, LAKISHA LATONYA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:LATONYA
Last Name:MAPP
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-2260
Mailing Address - Country:US
Mailing Address - Phone:404-234-7550
Mailing Address - Fax:
Practice Address - Street 1:5408 PARK CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2260
Practice Address - Country:US
Practice Address - Phone:404-234-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005878225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist