Healthcare Provider Details

I. General information

NPI: 1215677497
Provider Name (Legal Business Name): ASIA KAY LARSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 11/24/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W ACACIA ST
STOCKTON CA
95203-2405
US

IV. Provider business mailing address

10141 SW FLORIDA RD
COLONY KS
66015-9251
US

V. Phone/Fax

Practice location:
  • Phone: 209-944-5550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18-01577
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25793
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: