Provider Demographics
NPI:1124333794
Name:HANKINS, LATITIA MAHAN (MSOTRL)
Entity type:Individual
Prefix:
First Name:LATITIA
Middle Name:MAHAN
Last Name:HANKINS
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:LATITIA
Other - Middle Name:LYNN
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3750
Mailing Address - Country:US
Mailing Address - Phone:501-286-7711
Mailing Address - Fax:501-286-7711
Practice Address - Street 1:206 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3750
Practice Address - Country:US
Practice Address - Phone:501-286-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1124333794Medicaid