Provider Demographics
NPI:1356908420
Name:RUTLAND, LARRY JAMES (OTR/L)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JAMES
Last Name:RUTLAND
Suffix:
Gender:M
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 1:96232 RIDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8160
Mailing Address - Country:US
Mailing Address - Phone:678-761-2863
Mailing Address - Fax:904-775-4478
Practice Address - Street 1:22391 FLORA PARKE XING UNIT A
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-8005
Practice Address - Country:US
Practice Address - Phone:904-321-9054
Practice Address - Fax:855-565-1769
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21794225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist