Provider Demographics
NPI:1467909457
Name:HARRIS, CARLA C (MED IECE)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MED IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 TIMBERWALK CT
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-6746
Mailing Address - Country:US
Mailing Address - Phone:502-492-3844
Mailing Address - Fax:
Practice Address - Street 1:ASCB THERAPY
Practice Address - Street 2:4603 TIMBER WALK CT.
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8202
Practice Address - Country:US
Practice Address - Phone:502-492-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist