Provider Demographics
NPI:1518192194
Name:LARUE, CAROL F (OTR/L)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:F
Last Name:LARUE
Suffix:
Gender:F
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 1:55610 E 315 RD
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-5108
Mailing Address - Country:US
Mailing Address - Phone:913-341-6607
Mailing Address - Fax:
Practice Address - Street 1:55610 E 315 RD
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-5108
Practice Address - Country:US
Practice Address - Phone:913-341-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist