Provider Demographics
NPI:1093908105
Name:LARSON, ROCHELLE D (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:D
Last Name:LARSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17018 NEW MARKET DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-5328
Mailing Address - Country:US
Mailing Address - Phone:952-294-0707
Mailing Address - Fax:
Practice Address - Street 1:1455 ST FRANCIS AVE
Practice Address - Street 2:ST FRANCIS REGIONAL MEDICAL CENTER
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-403-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103048225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist