Provider Demographics
NPI:1528367695
Name:HARRIS, JAINEICIA MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JAINEICIA
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 EMBARCADERO W
Mailing Address - Street 2:#3203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3777
Mailing Address - Country:US
Mailing Address - Phone:510-691-9101
Mailing Address - Fax:
Practice Address - Street 1:15400 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1009
Practice Address - Country:US
Practice Address - Phone:510-895-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist