Provider Demographics
NPI:1699917039
Name:LARSEN, KAE LESLIE
Entity type:Individual
Prefix:
First Name:KAE
Middle Name:LESLIE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:L
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RRT
Mailing Address - Street 1:7521 SW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4402
Mailing Address - Country:US
Mailing Address - Phone:904-945-5488
Mailing Address - Fax:352-378-8602
Practice Address - Street 1:7521 SW 56TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4402
Practice Address - Country:US
Practice Address - Phone:904-945-5488
Practice Address - Fax:352-378-8602
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5024227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered