Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 106928 | TX |
NPI | 1063747483 |
---|---|
Provider Name | Karen Larsen |
First Address | Dallas, TX 75243-0587 |
Second Address | Plano, TX 75074-2546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2009 |
Last Update Date | 04/10/2009 |