Provider Demographics
NPI:1730857285
Name:LARSEN, GRAYDON DAN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:GRAYDON
Middle Name:DAN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 E JOHNSON WAY DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6345
Mailing Address - Country:US
Mailing Address - Phone:801-386-3967
Mailing Address - Fax:
Practice Address - Street 1:5284 S COMMERCE DR STE C214
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5568
Practice Address - Country:US
Practice Address - Phone:801-871-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12814739-4201225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics