Provider Demographics
NPI:1124001201
Name:HARRIS, MELANIE DIANE (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DIANE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:DIANE
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:3600 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2614
Mailing Address - Country:US
Mailing Address - Phone:606-242-1427
Mailing Address - Fax:606-242-1421
Practice Address - Street 1:3600 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2614
Practice Address - Country:US
Practice Address - Phone:606-242-1427
Practice Address - Fax:606-242-1421
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist