Provider Demographics
NPI:1568861391
Name:HARKLESS, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:HARKLESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BELDEN CT
Mailing Address - Street 2:T1
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3803
Mailing Address - Country:US
Mailing Address - Phone:413-231-6390
Mailing Address - Fax:
Practice Address - Street 1:2 BELDEN CT
Practice Address - Street 2:T1
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-3803
Practice Address - Country:US
Practice Address - Phone:413-231-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11313225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist