Individual
JACQUELINE RENEE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
7887 N 16TH ST, UNIT #125, PHOENIX, AZ 85020-4417
(419) 908-0892
Mailing address
7887 N 16TH ST, UNIT #125, PHOENIX, AZ 85020-4417
(419) 908-0892
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
04337
OH
224Z00000X
Occupational Therapy Assistant
Primary
4860
AZ
224Z00000X
Occupational Therapy Assistant
52020007306
MI
Other
Enumeration date
08/18/2011
Last updated
08/18/2011
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