Provider Demographics
NPI:1558677807
Name:HARLESS, JOSHUA AARON (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:AARON
Last Name:HARLESS
Suffix:
Gender:M
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 1:2064 WALSHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOOMER
Mailing Address - State:NC
Mailing Address - Zip Code:28606-9166
Mailing Address - Country:US
Mailing Address - Phone:336-651-8875
Mailing Address - Fax:336-667-0781
Practice Address - Street 1:2064 WALSHTOWN RD
Practice Address - Street 2:
Practice Address - City:BOOMER
Practice Address - State:NC
Practice Address - Zip Code:28606-9166
Practice Address - Country:US
Practice Address - Phone:336-651-8875
Practice Address - Fax:336-667-0781
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5041225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301640Medicaid