Provider Demographics
NPI:1851639843
Name:LARSON, AMBER LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEIGH
Last Name:LARSON
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 1:50 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350
Mailing Address - Country:US
Mailing Address - Phone:605-350-4735
Mailing Address - Fax:
Practice Address - Street 1:50 7TH ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2803
Practice Address - Country:US
Practice Address - Phone:605-554-0466
Practice Address - Fax:605-352-7742
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0814225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist