Provider Demographics
NPI:1578814877
Name:HARRIS, ENJOLI A (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ENJOLI
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ENJOLI
Other - Middle Name:A
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7621 WOOLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2612
Mailing Address - Country:US
Mailing Address - Phone:267-240-6752
Mailing Address - Fax:
Practice Address - Street 1:850 PAPER MILL RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-7833
Practice Address - Country:US
Practice Address - Phone:215-402-8833
Practice Address - Fax:215-836-4962
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC011956OtherOCCUPATIONAL THERAPY LICENSE