Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 000953 | IA |
NPI | 1003291402 |
---|---|
Provider Name | John Larkin |
First Address | Ottumwa, IA 52501-3940 |
Second Address | Ottumwa, IA 52501-3940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2015 |
Last Update Date | 27/07/2015 |