Individual
TATIANA SUZANNE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TRT
Contact information
Practice address
1001 N 500 W, PROVO, UT 84604-3305
(801) 977-9661
Mailing address
1001 N 500 W, PROVO, UT 84604-3305
(801) 977-9661
Taxonomy
Speciality
Code
Description
License number
State
226000000X
Recreational Therapist Assistant
Primary
141992834003
UT
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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