Provider Demographics
NPI:1861201477
Name:WHITTENBURG, LARISSA LYNN (OTR/L, CLC)
Entity type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:LYNN
Last Name:WHITTENBURG
Suffix:
Gender:F
Credentials:OTR/L, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 STATE HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-1728
Mailing Address - Country:US
Mailing Address - Phone:325-725-8338
Mailing Address - Fax:
Practice Address - Street 1:1132 HICKORY ST
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-4912
Practice Address - Country:US
Practice Address - Phone:325-728-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist