Provider Demographics
NPI:1942558267
Name:LATAILLE, SUZANNE M (MAT)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:LATAILLE
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 JAMES F BYRNES ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1940
Mailing Address - Country:US
Mailing Address - Phone:843-525-0023
Mailing Address - Fax:
Practice Address - Street 1:47 JAMES F BYRNES ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1940
Practice Address - Country:US
Practice Address - Phone:843-525-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist