Provider Demographics
NPI:1679624720
Name:LARSON, KATHLEEN HELEN (MS, OTR)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:HELEN
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 W CECIL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3718
Mailing Address - Country:US
Mailing Address - Phone:920-720-0237
Mailing Address - Fax:
Practice Address - Street 1:233 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:WINNECONNE
Practice Address - State:WI
Practice Address - Zip Code:54986-9646
Practice Address - Country:US
Practice Address - Phone:920-582-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI851-026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist