Provider Demographics
NPI:1326749789
Name:HARRISON, MATTIE LEE (MSOT, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:MATTIE
Middle Name:LEE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4172 W PYRACANTHA CIR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1339
Mailing Address - Country:US
Mailing Address - Phone:520-400-0726
Mailing Address - Fax:
Practice Address - Street 1:437 W THURBER RD STE 2
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6821
Practice Address - Country:US
Practice Address - Phone:520-293-5252
Practice Address - Fax:520-293-5454
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9068225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand