Provider Demographics
NPI:1609966746
Name:HARRIS, JOY LYNN (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:LYNN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GLEASON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2222
Mailing Address - Country:US
Mailing Address - Phone:781-395-6866
Mailing Address - Fax:781-393-8464
Practice Address - Street 1:23 GLEASON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-2222
Practice Address - Country:US
Practice Address - Phone:781-395-6866
Practice Address - Fax:781-393-8464
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1887225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0388939Medicaid