Provider Demographics
NPI:1083950448
Name:TUTTLE, LARYSA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LARYSA
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 REINHART WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2931
Mailing Address - Country:US
Mailing Address - Phone:502-384-6209
Mailing Address - Fax:
Practice Address - Street 1:6415 CALM RIVER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3250
Practice Address - Country:US
Practice Address - Phone:502-297-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY- R-4141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist