Individual
BONNIE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 MARIO CAPECCHI DR, SLC, UT 84113-1103
(801) 755-3792
Mailing address
1183 UNIVERSITY VLG, SLC, UT 84108-3505
Taxonomy
Speciality
Code
Description
License number
State
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
6609718-4201
UT
225XP0200X
Pediatric Occupational Therapist
6609718-4201
UT
Other
Enumeration date
08/20/2014
Last updated
08/20/2014
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