Provider Demographics
NPI:1326787904
Name:HARLAN, RILEY BETH (STUDENT)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:BETH
Last Name:HARLAN
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HUNTER VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9577
Mailing Address - Country:US
Mailing Address - Phone:501-428-5044
Mailing Address - Fax:
Practice Address - Street 1:4 HUNTER VALLEY LN
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9577
Practice Address - Country:US
Practice Address - Phone:501-428-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer