Provider Demographics
NPI:1386830131
Name:TREAT, LARISSA LEA (OT)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:LEA
Last Name:TREAT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 S GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4367
Mailing Address - Country:US
Mailing Address - Phone:319-351-5437
Mailing Address - Fax:319-351-5432
Practice Address - Street 1:1565 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4367
Practice Address - Country:US
Practice Address - Phone:319-351-5437
Practice Address - Fax:319-351-5432
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001845225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665463Medicaid
IA0665463Medicaid