Individual
LARISSA DAWN MCCOLLISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0766
SD
225X00000X
Occupational Therapist
4905-026
WI
Other
Enumeration date
10/20/2010
Last updated
08/19/2025
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