Provider Demographics
NPI:1760692412
Name:HARRIS, SANDRA LAWAN (OTR)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LAWAN
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 1:5340 CASINO DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-6627
Mailing Address - Country:US
Mailing Address - Phone:727-460-8096
Mailing Address - Fax:
Practice Address - Street 1:8254 118TH AVE N,
Practice Address - Street 2:SUITE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-541-5304
Practice Address - Fax:727-546-8527
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6473171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor