Provider Demographics
NPI:1013457084
Name:ECHAVARRIA, LATESS
Entity type:Individual
Prefix:
First Name:LATESS
Middle Name:
Last Name:ECHAVARRIA
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 1:2625 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-5185
Mailing Address - Country:US
Mailing Address - Phone:269-416-0549
Mailing Address - Fax:
Practice Address - Street 1:2625 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-5185
Practice Address - Country:US
Practice Address - Phone:269-416-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist