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Individual

MS. MARILYN LARSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
135 E PROSPECT ST, LAKE MILLS, WI 53551-1238
(920) 648-2338
Mailing address
135 E PROSPECT ST, LAKE MILLS, WI 53551-1238
(920) 648-2338

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1642-026
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
048414
DPI LICENSE
WI
Enumeration date
04/16/2008
Last updated
04/16/2008
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