Provider Demographics
NPI:1295294080
Name:PEOPLES, LAQUETTA DELORES (ED S)
Entity type:Individual
Prefix:
First Name:LAQUETTA
Middle Name:DELORES
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 ROTHSCHILD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-5124
Mailing Address - Country:US
Mailing Address - Phone:205-861-4527
Mailing Address - Fax:
Practice Address - Street 1:3475 ROTHSCHILD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-5124
Practice Address - Country:US
Practice Address - Phone:205-861-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist