Provider Demographics
NPI:1871760306
Name:HARRIS, YANDA LORRAINE (OTA)
Entity type:Individual
Prefix:
First Name:YANDA
Middle Name:LORRAINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2003
Mailing Address - Country:US
Mailing Address - Phone:770-754-0085
Mailing Address - Fax:
Practice Address - Street 1:11940 ALPHARETTA HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-2003
Practice Address - Country:US
Practice Address - Phone:770-754-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001087224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant