Provider Demographics
NPI:1386319549
Name:FERGUSON, LATISHA DOREEN (WTS)
Entity type:Individual
Prefix:MRS
First Name:LATISHA
Middle Name:DOREEN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:WTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13926 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2004
Mailing Address - Country:US
Mailing Address - Phone:240-205-5673
Mailing Address - Fax:
Practice Address - Street 1:2739 ATLANTA DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3739
Practice Address - Country:US
Practice Address - Phone:240-205-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier