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NPI Code Detail

MEDICARE: STACY LARSON

MEDICARE: STACY LARSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0019XPhysical Rehabilitation Occupational Therapist118964TX

General Provider Information

NPI Number : 1508643768
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY LARSON
Provider Business Mailing Address
First Line : 2821 BERRY WAY
Second Line :
City : SCHERTZ
State : TX
Zip : 78154-5403
Country : US
Telephone Number : 307-274-1179
Fax Number :
Provider Business Practice Location Address
First Line : 816 EVERYDAY WAY
Second Line :
City : CIBOLO
State : TX
Zip : 78108-4080
Country : US
Telephone Number : 210-538-3812
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2023
Last Update Date : 09/12/2023

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Directions to “ STACY LARSON ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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