Provider Demographics
NPI:1356914535
Name:KUBINSKI, LARRA
Entity type:Individual
Prefix:
First Name:LARRA
Middle Name:
Last Name:KUBINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 S METZLETEIN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVER
Mailing Address - State:MO
Mailing Address - Zip Code:65631-6208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2540 S METZLETEIN RD
Practice Address - Street 2:
Practice Address - City:CLEVER
Practice Address - State:MO
Practice Address - Zip Code:65631-6208
Practice Address - Country:US
Practice Address - Phone:573-855-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019011702225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist