Provider Demographics
NPI:1730108440
Name:WOOD, LARRY LESTER (MS)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LESTER
Last Name:WOOD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 E FRAZIER ST
Mailing Address - Street 2:
Mailing Address - City:DREXEL
Mailing Address - State:MO
Mailing Address - Zip Code:64742-8223
Mailing Address - Country:US
Mailing Address - Phone:816-657-4667
Mailing Address - Fax:
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:RECREATION THERAPY 135
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist