Provider Demographics
NPI:1285104778
Name:LEDESMA, LATISCHA
Entity type:Individual
Prefix:
First Name:LATISCHA
Middle Name:
Last Name:LEDESMA
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 1:97 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7519
Mailing Address - Country:US
Mailing Address - Phone:978-902-5429
Mailing Address - Fax:
Practice Address - Street 1:75 DAY STREET
Practice Address - Street 2:MAILROOM
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-0142
Practice Address - Country:US
Practice Address - Phone:978-902-5429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist