Provider Demographics
NPI:1770151508
Name:LARGAR, DALLAS CRYSTAL (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:DALLAS
Middle Name:CRYSTAL
Last Name:LARGAR
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8283
Mailing Address - Country:US
Mailing Address - Phone:845-492-6879
Mailing Address - Fax:
Practice Address - Street 1:59 WINDSOR HWY
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-6233
Practice Address - Country:US
Practice Address - Phone:845-485-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist