Provider Demographics
NPI:1528024221
Name:HARRISON, VALARIE KAREN ROBERSON (OTA)
Entity Type:Individual
Prefix:MRS
First Name:VALARIE
Middle Name:KAREN ROBERSON
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 E SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819
Mailing Address - Country:US
Mailing Address - Phone:229-243-8551
Mailing Address - Fax:229-243-0200
Practice Address - Street 1:713 E SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819
Practice Address - Country:US
Practice Address - Phone:229-243-8551
Practice Address - Fax:229-243-0200
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA000619224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant