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General NPI Number Information
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NPI Number | 1861201477
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Entity Type | Individual
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Provider Name | LARISSA LYNN WHITTENBURG OTR/L, CLC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1132 HICKORY ST
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City | COLORADO CITY
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State | TX
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Zip | 79512-4912
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Country | US
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Telephone | 325-728-5312
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 STATE HIGHWAY 70
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City | SWEETWATER
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State | TX
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Zip | 79556-1728
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Country | US
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Telephone | 325-725-8338
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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 | 120683
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License Number State | TX
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