Provider Demographics
NPI:1437767928
Name:HARRIS, ABIGAIL EVELYN LEIGH (OTD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:EVELYN LEIGH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 BERKLEY CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-6371
Mailing Address - Country:US
Mailing Address - Phone:815-315-7526
Mailing Address - Fax:
Practice Address - Street 1:1201 W ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1003
Practice Address - Country:US
Practice Address - Phone:707-387-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006420225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist