Provider Demographics
NPI:1760705651
Name:LARSON, CAROLINE H (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:H
Last Name:LARSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:79 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1639
Mailing Address - Country:US
Mailing Address - Phone:781-275-9338
Mailing Address - Fax:781-275-4994
Practice Address - Street 1:79 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1639
Practice Address - Country:US
Practice Address - Phone:781-275-9338
Practice Address - Fax:781-275-4994
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA528225X00000X, 225XF0002X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing