Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2020029823 | MO |
NPI | 1003400375 |
---|---|
Provider Name | Hannah Larson |
First Address | Blue Springs, MO 64014-5586 |
Second Address | Blue Springs, MO 64015-9501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2021 |
Last Update Date | 26/02/2021 |