Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 0119006624 | VA |
NPI | 1760857676 |
---|---|
Provider Name | Dana Larson |
First Address | Richmond, VA 23233-7013 |
Second Address | Richmond, VA 23233-1332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2015 |
Last Update Date | 03/12/2015 |