Individual
DONALD LEE LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L, RN
Contact information
Practice address
11565 HARTS RD, JACKSONVILLE, FL 32218-3777
(904) 751-1834
Mailing address
4205 VICTORIA LAKES DR W, JACKSONVILLE, FL 32226-0705
(904) 502-3866
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA8970
FL
Other
Enumeration date
01/10/2012
Last updated
01/10/2012
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