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Individual

JOSHUA AARON HARLESS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OTR/L

Contact information

Practice address
2064 WALSHTOWN RD, BOOMER, NC 28606-9166
(336) 651-8875
(336) 667-0781
Mailing address
2064 WALSHTOWN RD, BOOMER, NC 28606-9166
(336) 651-8875
(336) 667-0781

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5041
NC
225XP0200X
Pediatric Occupational Therapist
5041
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7301640
NC
Enumeration date
08/25/2010
Last updated
09/16/2011
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