Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5493 | CT |
N | 225XM0800X | Mental Health | 5493 | CT |
N | 225XP0200X | Occupational Therapist - Pediatrics | 5493 | CT |
NPI | 1649833476 |
---|---|
Provider Name | Melina Larsen |
First Address | Torrington, CT 06790-7224 |
Second Address | Torrington, CT 06790-7224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2019 |
Last Update Date | 05/05/2021 |