Provider Demographics
NPI:1073018354
Name:HARVEY, RAELENE S (OT)
Entity Type:Individual
Prefix:MRS
First Name:RAELENE
Middle Name:S
Last Name:HARVEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 EDMOND DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1523
Mailing Address - Country:US
Mailing Address - Phone:219-322-1415
Mailing Address - Fax:219-322-1414
Practice Address - Street 1:440 EDMOND DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1523
Practice Address - Country:US
Practice Address - Phone:219-322-1415
Practice Address - Fax:219-322-1414
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist