Provider Demographics
NPI:1235223488
Name:HARRISON, MARY BETH (CVRT, CLVT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CVRT, CLVT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2955 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546
Mailing Address - Country:US
Mailing Address - Phone:708-447-5765
Mailing Address - Fax:
Practice Address - Street 1:5TH AVENUE AND ROOSEVELT ROAD
Practice Address - Street 2:BUILDING 113
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5000
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-7949
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind