Provider Demographics
NPI:1073514501
Name:HARRIS-CHAMPION, MONYCA R (OT)
Entity Type:Individual
Prefix:
First Name:MONYCA
Middle Name:R
Last Name:HARRIS-CHAMPION
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 1:324 COOL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1631
Mailing Address - Country:US
Mailing Address - Phone:615-791-7257
Mailing Address - Fax:615-591-6336
Practice Address - Street 1:324 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1631
Practice Address - Country:US
Practice Address - Phone:615-791-7257
Practice Address - Fax:615-591-6336
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3073225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3656538Medicaid
TN3656538Medicaid