Provider Demographics
NPI:1871705350
Name:HARRIS, TASHA NICOLE (OTR L)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 N. GOLDEN EYE CT.
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5320
Mailing Address - Country:US
Mailing Address - Phone:870-425-5629
Mailing Address - Fax:
Practice Address - Street 1:58 N. GOLDEN EYE CT.
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5320
Practice Address - Country:US
Practice Address - Phone:870-425-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1330225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist