Provider Demographics
NPI:1164931507
Name:LARSON, KIRSTEN ETTA (LMP)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:ETTA
Last Name:LARSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223
Mailing Address - Country:US
Mailing Address - Phone:707-690-8936
Mailing Address - Fax:
Practice Address - Street 1:3209 E 57TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223
Practice Address - Country:US
Practice Address - Phone:509-448-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60763632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist