Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OTR485 | WY |
Y | 225XH1200X | Occupational Therapist - Hand | 0119004545 | VA |
NPI | 1023098423 |
---|---|
Provider Name | Kathryn Larson |
First Address | Roanoke, VA 24018-6438 |
Second Address | Roanoke, VA 24018-6438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
312199 | BCBS (01) | |
P00081343 | RAILROAD MEDICARE (01) |