Individual
MRS. ROBERTA S. LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7848 S ELM PL, BROKEN ARROW, OK 74011-4353
(918) 994-7575
Mailing address
817 S ELM PL STE 100, BROKEN ARROW, OK 74012-5369
(918) 557-6534
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
101774
OK
225700000X
Massage Therapist
Primary
MT040151
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101774
MASSAGE THERAPY BOARD/LICENSE
OK
Enumeration date
12/13/2010
Last updated
02/24/2021
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