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General NPI Number Information
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NPI Number | 1215677497
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Entity Type | Individual
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Provider Name | ASIA KAY LARSEN
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Gender | Female
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 11/24/2024
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Provider Practice Location Address
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Address Line | 525 W ACACIA ST
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City | STOCKTON
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State | CA
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Zip | 95203-2405
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Country | US
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Telephone | 209-944-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 10141 SW FLORIDA RD
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City | COLONY
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State | KS
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Zip | 66015-9251
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Country | US
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Telephone |
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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 | 25793
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 18-01577
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT24576
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License Number State | FL
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