Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Latasha Nicole Mallard

Individual provider Occupational Therapy Assistant · NPI 1053183723

Latasha Nicole Mallard is an Occupational Therapy Assistant in Carrollton, Georgia. Licensed in Georgia. Registered with an NPI since 2023.

Licensed in
GA
In the registry since
2023

Practice location Address checks out

150 Cottage Ln
Carrollton, GA 30117-6200
Phone: (770) 830-8857
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapy Assistant (primary) Taxonomy 224Z00000X · Licence OTA002989 (GA)

Record details

NPI number1053183723
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 26, 2023
Last updated in NPPESOctober 26, 2023
Certification dateOctober 26, 2023

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