Provider Demographics
NPI:1386023117
Name:HARRIS, GLENN EDWARD (OTR)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:EDWARD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7824 HARVEST HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-7348
Mailing Address - Country:US
Mailing Address - Phone:817-881-3221
Mailing Address - Fax:
Practice Address - Street 1:900 WESTPARK WAY
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3977
Practice Address - Country:US
Practice Address - Phone:817-545-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110257225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist