Basic Information
Provider Information | |||||||||
NPI: | 1518157015 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LARSON | ||||||||
FirstName: | KRISTEN | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | OTR/L, CHT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HEDENSKOG | ||||||||
OtherFirstName: | KRISTEN | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 17134 BEL RAY PL | ||||||||
Address2: |   | ||||||||
City: | BELTON | ||||||||
State: | MO | ||||||||
PostalCode: | 640125331 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8162264011 | ||||||||
FaxNumber: | 8165246115 | ||||||||
Practice Location | |||||||||
Address1: | 7932 N OAK TRFY | ||||||||
Address2: | SUITE 212 | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641181423 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8164200286 | ||||||||
FaxNumber: | 8164208207 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2007 | ||||||||
LastUpdateDate: | 01/27/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 004600 | MO | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
ID | Type | State | Issuer | Description | 39315041 | 01 |   | BCBS KC | OTHER | MA4370038 | 01 | MO | MEDICARE PTAN | OTHER |