Provider Demographics
NPI:1710591169
Name:HARRY, ALLISON JANE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JANE
Last Name:HARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 WHITFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2767
Mailing Address - Country:US
Mailing Address - Phone:248-623-0528
Mailing Address - Fax:
Practice Address - Street 1:3258 WHITFIELD CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-2767
Practice Address - Country:US
Practice Address - Phone:248-623-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer