Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT3105 | FL |
Y | 225XM0800X | Mental Health | OT3105 | FL |
NPI | 1962833723 |
---|---|
Provider Name | Mr. Ralph Edward Harris |
First Address | Gainesville, FL 32608-1135 |
Second Address | Gainesville, FL 32608-1135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2013 |
Last Update Date | 04/12/2013 |