Provider Demographics
NPI:1467051862
Name:LARSEN, MARK TODD JR (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:TODD
Last Name:LARSEN
Suffix:JR
Gender:M
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 1:1000 EASTON RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2900
Mailing Address - Country:US
Mailing Address - Phone:215-517-7551
Mailing Address - Fax:
Practice Address - Street 1:1000 EASTON RD STE 207
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2900
Practice Address - Country:US
Practice Address - Phone:215-517-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017203225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand