Healthcare Provider Details

I. General information

NPI: 1154031995
Provider Name (Legal Business Name): TRISHA LARSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MCCLURG CT APT 1609
CHICAGO IL
60611-4371
US

IV. Provider business mailing address

400 N MCCLURG CT APT 1609
CHICAGO IL
60611-4371
US

V. Phone/Fax

Practice location:
  • Phone: 906-399-8594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: