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General NPI Number Information
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NPI Number | 1538615943
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Entity Type | Individual
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Provider Name | JACOB LARSON OTD
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Gender | Male
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Dates
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Enumeration Date | 08/27/2016
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Last Update Date | 08/27/2016
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Provider Practice Location Address
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Address Line | 1992 W ANTELOPE DR SUITE 1-D
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City | LAYTON
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State | UT
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Zip | 84041-4953
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Country | US
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Telephone | 801-773-2633
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Fax | 801-773-1553
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Provider Business Mailing Address
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Address Line | 1992 W ANTELOPE DR SUITE 1-D
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City | LAYTON
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State | UT
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Zip | 84041-4953
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Country | US
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Telephone | 801-773-2633
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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 | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 9829767-4201
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License Number State | UT
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