Provider Demographics
NPI:1053690495
Name:ELGEN, LATASHA (COTA/L)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:ELGEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1164
Mailing Address - Country:US
Mailing Address - Phone:513-551-3309
Mailing Address - Fax:
Practice Address - Street 1:1978 QUEEN CITY AVENUE APT. 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45204-1047
Practice Address - Country:US
Practice Address - Phone:513-551-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
OHOTA005546224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No376K00000XNursing Service Related ProvidersNurse's Aide