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Individual

MRS. ALISA L LARUE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
1030 E HIGHWAY 377 STE 202, GRANBURY, TX 76048-1460
(817) 279-6646
Mailing address
1030 E HIGHWAY 377 STE 202, GRANBURY, TX 76048-1460

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
111982
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201563801
TX
01
822T67
BLUE CROSS BLUE SHIELD
Enumeration date
01/13/2009
Last updated
11/07/2011
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