Provider Demographics
NPI:1164929097
Name:LARKIN, VICTORIA ELAINE (OTR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELAINE
Last Name:LARKIN
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 1:1140 SPRING HILL RD
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-9233
Mailing Address - Country:US
Mailing Address - Phone:612-719-6176
Mailing Address - Fax:
Practice Address - Street 1:14000 NORTHDALE BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4662
Practice Address - Country:US
Practice Address - Phone:952-544-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
398394225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist