Healthcare Provider Details

I. General information

NPI: 1487230355
Provider Name (Legal Business Name): LAUREN M LARSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S CEDAR ST
SPOKANE WA
99201-7029
US

IV. Provider business mailing address

319 S CEDAR ST
SPOKANE WA
99201-7029
US

V. Phone/Fax

Practice location:
  • Phone: 509-209-7429
  • Fax: 509-340-9942
Mailing address:
  • Phone: 509-209-7429
  • Fax: 509-340-9942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61132724
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: