Provider Demographics
NPI:1659538528
Name:LARKIN, JANE HEATHER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:HEATHER
Last Name:LARKIN
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 1:877 GALYON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-8977
Mailing Address - Country:US
Mailing Address - Phone:901-652-1917
Mailing Address - Fax:
Practice Address - Street 1:83 AIRWAYS PL
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5885
Practice Address - Country:US
Practice Address - Phone:662-349-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2198225X00000X
TNOT3562225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist