Provider Demographics
NPI:1063757656
Name:LARSON, ABBY
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 LIVE OAK AVE
Mailing Address - Street 2:APT B
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:765 LIVE OAK AVE
Practice Address - Street 2:APT B
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4866
Practice Address - Country:US
Practice Address - Phone:785-341-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13083225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist