Stacy Lynn Larson

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

057000615 Issued in IL

Practice address

19015 S Jodi Rd Ste a
Mokena, IL 60448-8534

Phone

(708) 478-7786

NPI assigned

Nov 27, 2012

Last updated

Nov 27, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stacy Larson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353974400000",
    "number": "1326383688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 TIMBERS BLUFF TRL",
            "city": "BEECHER",
            "state": "IL",
            "postal_code": "604015112",
            "telephone_number": "708-946-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19015 S JODI RD STE A",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488534",
            "telephone_number": "708-478-7786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "STACY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-27",
        "last_updated": "2012-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "057000615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFED OCCUPATIONAL THERAPY ASSISTANT",
            "identifier": "057000615",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "LARSON",
            "credential": "COTA/L",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Donita Michelle Lake
• Emily Lang, FNP-BC
• Joy Lantz
• Jeanelle D Lao
• Carolyn Larson, PHARMD
• Theresa M Larson, FNP-BC
• Marissa Lynn Latko
• Eun-Yeop Lee, PHD
• Leon J Witkowski Jr DDS LTD
• Emma Jean Leto, MS, BCBA

• Occupational Therapist in Mokena, IL
• Providers in Mokena, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.