Provider Demographics
NPI:1447993159
Name:HARRIS, NICOLE ASIA (OTA/L)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ASIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 5TH AVE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035
Mailing Address - Country:US
Mailing Address - Phone:347-387-1449
Mailing Address - Fax:
Practice Address - Street 1:2117 5TH AVE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1046
Practice Address - Country:US
Practice Address - Phone:347-387-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009518224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant