Provider Demographics
NPI:1235968017
Name:HARRIS, JEFF T
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:T
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 MALLARD LN APT 1
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3609
Mailing Address - Country:US
Mailing Address - Phone:330-284-3684
Mailing Address - Fax:
Practice Address - Street 1:2308 MALLARD LN APT 1
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3609
Practice Address - Country:US
Practice Address - Phone:330-284-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty