Provider Demographics
NPI:1043515513
Name:HARRISON, ANGELA R (OT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:R
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:1001 SE 62ND BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5925
Practice Address - Country:US
Practice Address - Phone:352-379-5507
Practice Address - Fax:352-379-5507
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT7389225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist