Provider Demographics
NPI:1588025225
Name:HARMON, MISHKA J (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MISHKA
Middle Name:J
Last Name:HARMON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:MISSY
Other - Middle Name:J
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:109 HARMON POND CIR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-9052
Mailing Address - Country:US
Mailing Address - Phone:803-917-4677
Mailing Address - Fax:803-404-6406
Practice Address - Street 1:1624 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2818
Practice Address - Country:US
Practice Address - Phone:803-454-0365
Practice Address - Fax:803-404-6406
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1323224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant