Individual
MYSTIE ANN HARMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1536 CLAIBORNE AVE, SHREVEPORT, LA 71103-4206
(903) 407-9114
Mailing address
1536 CLAIBORNE AVE, SHREVEPORT, LA 71103-4206
(903) 407-9114
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
Z20632
LA
Other
Enumeration date
03/08/2012
Last updated
03/08/2012
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