Provider Demographics
NPI:1053486449
Name:HARLAN, TEARSA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TEARSA
Middle Name:
Last Name:HARLAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JACOB
Mailing Address - State:IL
Mailing Address - Zip Code:62281-1073
Mailing Address - Country:US
Mailing Address - Phone:314-776-4320
Mailing Address - Fax:314-776-1875
Practice Address - Street 1:3815 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-4025
Practice Address - Country:US
Practice Address - Phone:314-776-4320
Practice Address - Fax:314-776-1875
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006003744225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics