Provider Demographics
NPI:1639355167
Name:HARRIS, LERON (OT-A)
Entity Type:Individual
Prefix:MR
First Name:LERON
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:OT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 ELDRIDGE AVE E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-4032
Mailing Address - Country:US
Mailing Address - Phone:870-208-8989
Mailing Address - Fax:870-208-8107
Practice Address - Street 1:707 ELDRIDGE AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4032
Practice Address - Country:US
Practice Address - Phone:870-208-8989
Practice Address - Fax:870-208-8107
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A117224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant