Individual
MRS. STEPHANIE ANN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4121 E VALLEY AUTO DR # 100, MESA, AZ 85206-4631
(480) 687-4271
(480) 422-2436
Mailing address
5615 E ENROSE ST, MESA, AZ 85205-5857
(148) 098-1792
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
006336
AZ
Other
Enumeration date
07/22/2022
Last updated
07/22/2022
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