Healthcare Provider Details

I. General information

NPI: 1205474400
Provider Name (Legal Business Name): JOHANNA LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 10TH AVE
TOPEKA KS
66604-1301
US

IV. Provider business mailing address

325 SW FRAZIER AVE
TOPEKA KS
66606-1963
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-6000
  • Fax:
Mailing address:
  • Phone: 785-232-5005
  • Fax: 888-972-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18-01838
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: