Provider Demographics
NPI:1235713579
Name:HARRIS, AUDRA LISA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:LISA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WEST ST APT 12
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-6336
Mailing Address - Country:US
Mailing Address - Phone:978-855-9636
Mailing Address - Fax:
Practice Address - Street 1:931 BOSTON RD
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-6927
Practice Address - Country:US
Practice Address - Phone:978-241-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13275225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist