Provider Demographics
NPI:1194988055
Name:MCGRAW, LATISHA TAVAUGHNA (MS OTR-L)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:TAVAUGHNA
Last Name:MCGRAW
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 1:3160 FREESTONE CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-3090
Mailing Address - Country:US
Mailing Address - Phone:410-569-6550
Mailing Address - Fax:
Practice Address - Street 1:200 E NORTH AVENUE
Practice Address - Street 2:BALTIMORE CITY PUBLIC SCHOOLS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:202-531-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist