Provider Demographics
NPI:1659637718
Name:HARRIS, MOLLY W (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:W
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 1:750 E. ADAMS ST.
Mailing Address - Street 2:PHYSICAL MEDICINE & REHABILITATION
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-2300
Mailing Address - Fax:315-464-1901
Practice Address - Street 1:750 E. ADAMS ST.
Practice Address - Street 2:PHYSICAL MEDICINE & REHABILITATION
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-2300
Practice Address - Fax:315-464-1901
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63-01766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161469571Medicaid