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Individual

MARY LOUISE LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
425 DAVIS ST, HAMMOND, WI 54015-9615
(715) 796-2218
Mailing address
970 BAKKEN RD, HUDSON, WI 54016-7625
(715) 410-7202

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1204-26
WI

Other

Enumeration date
01/25/2013
Last updated
01/25/2013
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