Healthcare Provider Details

I. General information

NPI: 1114976644
Provider Name (Legal Business Name): KRISTIE LYNN LARSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CDR LRMC #402
APO AE
09180
US

IV. Provider business mailing address

PSC 2 BOX 13097
APO AE
09012-3097
US

V. Phone/Fax

Practice location:
  • Phone: 06371868383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: