Provider Demographics
NPI:1629388806
Name:MCCOLLISTER, LARISSA DAWN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:DAWN
Last Name:MCCOLLISTER
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 E JASPER CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6805
Mailing Address - Country:US
Mailing Address - Phone:605-366-5647
Mailing Address - Fax:
Practice Address - Street 1:201 E 38TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5815
Practice Address - Country:US
Practice Address - Phone:605-367-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4905-026225X00000X
SD0766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist