Provider Demographics
NPI:1578583712
Name:HARRIS, MARIA J (OTRL)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9645 GROVE CIR N STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-2684
Mailing Address - Country:US
Mailing Address - Phone:763-201-8191
Mailing Address - Fax:
Practice Address - Street 1:172 COBBLESTONE LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4578
Practice Address - Country:US
Practice Address - Phone:763-201-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP48922OtherHEALTH PARTNERS
MN6401989OtherMEDICA PRIMARY
MN6401990OtherMEDICA CHOICE/ SELECT CAR
MNA004OtherTRICARE
MN1089018OtherAMERICAS PPO/ARAZ
MN167565F703OtherUCARE
MN509491028653OtherPREFERRED ONE INS
MN51D56HAOtherBCBS OF MN