Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP000808L | PA |
NPI | 1023259124 |
---|---|
Provider Name | Jill Harris |
First Address | Lafayette Hill, PA 19444-2340 |
Second Address | Plymouth Meeting, PA 19462-1047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2009 |
Last Update Date | 19/03/2009 |