Provider Demographics
NPI:1154835726
Name:FARRIS, JOANNE TALA (ACC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:TALA
Last Name:FARRIS
Suffix:
Gender:F
Credentials:ACC
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:TALA
Other - Last Name:FARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACC
Mailing Address - Street 1:975 KIRMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0993
Mailing Address - Country:US
Mailing Address - Phone:775-785-7190
Mailing Address - Fax:
Practice Address - Street 1:975 KIRMAN AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-0993
Practice Address - Country:US
Practice Address - Phone:775-785-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-18
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVACC300024OtherNATIONAL CERTIFICATION COUNCIL FOR ACTIVITY PROFESSIONALSACC
NV1170083333OtherATHLETICS AND FITNESS ASSOCIATION