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General NPI Number Information
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NPI Number | 1144170150
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Entity Type | Individual
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Provider Name | ALYSSA SUE LARSON
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Gender | Female
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 21651 E COUNTRY VISTA DR
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-7708
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Country | US
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Telephone | 208-966-4176
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1180
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City | HAYDEN
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State | ID
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Zip | 83835-1180
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Country | US
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Telephone | 208-966-4176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT70086610
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License Number State | WA
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