Individual
MRS. KALIE ANN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
370 S 200 E, BSMT, PROVO, UT 84606-4608
(509) 389-4172
Mailing address
370 S 200 E, BSMT, PROVO, UT 84606-4608
(509) 389-4172
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8334450-4701
UT
Other
Enumeration date
08/16/2012
Last updated
08/16/2012
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