Provider Demographics
NPI:1649833476
Name:LARSEN, MELINA (OT, R/L)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:OT, R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-7224
Mailing Address - Country:US
Mailing Address - Phone:860-673-0145
Mailing Address - Fax:860-672-1400
Practice Address - Street 1:61 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-7224
Practice Address - Country:US
Practice Address - Phone:860-673-0145
Practice Address - Fax:860-672-1400
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5493225XM0800X, 225XP0200X, 225X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program