Provider Demographics
NPI:1023098423
Name:LARSON, KATHRYN (OTR)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4064 POSTAL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6438
Mailing Address - Country:US
Mailing Address - Phone:540-776-0208
Mailing Address - Fax:540-777-5847
Practice Address - Street 1:4064 POSTAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6438
Practice Address - Country:US
Practice Address - Phone:540-776-0208
Practice Address - Fax:540-777-5847
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR485225X00000X
VA0119004545225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
312199OtherBCBS
P00081343OtherRAILROAD MEDICARE
P00081343OtherRAILROAD MEDICARE