Provider Demographics
NPI:1881157303
Name:LARSON, KRISTOPHER NILS
Entity type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:NILS
Last Name:LARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9368 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 POND PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4354
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-741-6230
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist