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Individual
AMANDA LARSON
Active
Individual
AMANDA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5725
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5725
LICENSE
WI
Enumeration date
05/11/2016
Last updated
05/11/2016
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