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NPI Code Detail

MEDICARE: MELODIE LARSON MOTR/L

MEDICARE: MELODIE LARSON MOTR/L
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
1225XP0200XPediatric Occupational Therapist105241MN

General Provider Information

NPI Number : 1952851305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELODIE LARSON MOTR/L
Provider Business Mailing Address
First Line : 5710 BAKER RD
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-5901
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3380 NORTHERN VALLEY PL NE # OI
Second Line :
City : ROCHESTER
State : MN
Zip : 55906-3954
Country : US
Telephone Number : 507-923-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2016
Last Update Date : 10/10/2016

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Directions to “ MELODIE LARSON MOTR/L” Practice Location

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