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Individual

LATASHA LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
19120 MYSTIQUE DR, CORCORAN, MN 55340-9586
(320) 293-3205
Mailing address
19120 MYSTIQUE DR, CORCORAN, MN 55340-9586
(320) 293-3205

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
103693
MN
225XE0001X
Environmental Modification Occupational Therapist
Primary
103693
MN
225XG0600X
Gerontology Occupational Therapist
103693
MN

Other

Enumeration date
09/21/2021
Last updated
01/17/2023
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