Provider Demographics
NPI:1225300478
Name:HARRIS, CHRISTINE MARY (MSOT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W FLESHIEM ST
Mailing Address - Street 2:IRON MOUNTAIN
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-1534
Mailing Address - Country:US
Mailing Address - Phone:906-779-2197
Mailing Address - Fax:
Practice Address - Street 1:408 W FLESHIEM ST
Practice Address - Street 2:IRON MOUNTAIN
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-1534
Practice Address - Country:US
Practice Address - Phone:906-779-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4724-26225X00000X
MI5201002918225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist