Provider Demographics
NPI:1659304293
Name:HARLESS, JENNIFER LINDSEY (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LINDSEY
Last Name:HARLESS
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 RIVERS BEND BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8632
Mailing Address - Country:US
Mailing Address - Phone:804-571-5106
Mailing Address - Fax:804-530-1857
Practice Address - Street 1:131 JENNICK DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-4905
Practice Address - Country:US
Practice Address - Phone:804-526-5888
Practice Address - Fax:804-526-5401
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000261225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659304293Medicaid
VAP00401744OtherRAILROAD MEDICARE
VA011169C67Medicare PIN
VAP00401744OtherRAILROAD MEDICARE