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General NPI Number Information
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NPI Number | 1225171937
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Entity Type | Organization
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Legal Business Name | D. JAYNE LARSON ET AL PTR
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 3724 JEFFERSON ST SUITE 316
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City | AUSTIN
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State | TX
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Zip | 78731-6222
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Country | US
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Telephone | 512-453-6778
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Fax | 512-453-6995
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Provider Business Mailing Address
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Address Line | 3724 JEFFERSON ST SUITE 316
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City | AUSTIN
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State | TX
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Zip | 78731-6222
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Country | US
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Telephone | 512-453-6778
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Fax | 512-453-6995
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. DEBORAH JAYNE LARSON
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Credential | M.S.,CCC-SLP
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Telephone | 512-453-6778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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