Organization
STAFFREHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATASHA LYNN-DIONYSIUS LARSON OTR/L (OCCUPATIONAL THERAPIST)
(320) 293-3205
Entity
Organization
Contact information
Practice address
5000 BIRCH ST, 3000 WEST TOWER, NEWPORT BEACH, CA 92660-2127
(188) 883-5089
Mailing address
5000 BIRCH ST, 3000 WEST TOWER, NEWPORT BEACH, CA 92660-2127
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
103693
MN
Other
Enumeration date
08/03/2011
Last updated
08/03/2011
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