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General NPI Number Information
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NPI Number | 1356908420
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Entity Type | Individual
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Provider Name | LARRY JAMES RUTLAND OTR/L
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Gender | Male
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 22391 FLORA PARKE XING UNIT A
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-8005
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Country | US
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Telephone | 904-321-9054
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Fax | 855-565-1769
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Provider Business Mailing Address
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Address Line | 96232 RIDGEWOOD CIR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-8160
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Country | US
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Telephone | 678-761-2863
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Fax | 904-775-4478
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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 | OT21794
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License Number State | FL
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