Provider Demographics
NPI:1912284365
Name:LARSON, MEGAN (LCPO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SW 156TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2562
Mailing Address - Country:US
Mailing Address - Phone:235-216-0777
Mailing Address - Fax:253-216-0778
Practice Address - Street 1:127 SW 156TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2562
Practice Address - Country:US
Practice Address - Phone:235-216-0777
Practice Address - Fax:253-216-0778
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI 60269456222Z00000X
224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist