Provider Demographics
NPI:1073001152
Name:LAROWE, JAMES (ODT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LAROWE
Suffix:
Gender:M
Credentials:ODT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12844 COLDWATER RD STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8833
Mailing Address - Country:US
Mailing Address - Phone:260-497-7191
Mailing Address - Fax:260-497-7791
Practice Address - Street 1:12844 COLDWATER RD STE C
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8833
Practice Address - Country:US
Practice Address - Phone:260-497-7191
Practice Address - Fax:260-497-7791
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006595A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist