Healthcare Provider Details

I. General information

NPI: 1023098423
Provider Name (Legal Business Name): KATHRYN LARSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4064 POSTAL DR
ROANOKE VA
24018-6438
US

IV. Provider business mailing address

4064 POSTAL DR
ROANOKE VA
24018-6438
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-0208
  • Fax: 540-777-5847
Mailing address:
  • Phone: 540-776-0208
  • Fax: 540-777-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR485
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0119004545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: