Provider Demographics
NPI:1730471491
Name:HARRIS, TERRI A (OTR)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:KARVAL
Mailing Address - State:CO
Mailing Address - Zip Code:80823-0123
Mailing Address - Country:US
Mailing Address - Phone:719-760-0041
Mailing Address - Fax:
Practice Address - Street 1:1081 8TH ST
Practice Address - Street 2:
Practice Address - City:LIMON
Practice Address - State:CO
Practice Address - Zip Code:80828-1028
Practice Address - Country:US
Practice Address - Phone:719-760-0041
Practice Address - Fax:719-743-2093
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1754225XP0019X
ND225XP0200X
ND1936225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation