Healthcare Provider Details

I. General information

NPI: 1477647972
Provider Name (Legal Business Name): KAREN ANN LARSEN OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVE B SE
WINTER HAVEN FL
35880
US

IV. Provider business mailing address

150 AVE B SE
WINTER HAVEN FL
35880
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-1429
  • Fax: 863-298-0299
Mailing address:
  • Phone: 863-294-1429
  • Fax: 863-298-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 12451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: