Provider Demographics
NPI:1760857676
Name:LARSON, DANA (MS OTR/L, CBIS)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:MS OTR/L, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13454 N GAYTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7013
Mailing Address - Country:US
Mailing Address - Phone:804-364-3305
Mailing Address - Fax:
Practice Address - Street 1:3721 WESTERRE PKWY
Practice Address - Street 2:STE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1332
Practice Address - Country:US
Practice Address - Phone:804-270-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006624225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation