Provider Demographics
NPI:1588003172
Name:SWAIN, LARISSA (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BURKE AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-1238
Mailing Address - Country:US
Mailing Address - Phone:970-306-5210
Mailing Address - Fax:
Practice Address - Street 1:1020 N WENATCHEE AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1532
Practice Address - Country:US
Practice Address - Phone:509-665-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3967225X00000X, 225X00000X
OR313375225X00000X
WAOT60644971225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist