Provider Demographics
NPI:1679864045
Name:HARRISON, RUTH PHILLIPS (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:PHILLIPS
Last Name:HARRISON
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 1:2015 BONNIE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8600
Mailing Address - Country:US
Mailing Address - Phone:239-218-3373
Mailing Address - Fax:
Practice Address - Street 1:2015 BONNIE OAKS DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-8600
Practice Address - Country:US
Practice Address - Phone:239-218-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist