Provider Demographics
NPI:1821635731
Name:HARRIS, ERIN ELISE (MA 60927978)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA 60927978
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6492 19TH ST W APT D
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6109
Mailing Address - Country:US
Mailing Address - Phone:360-590-9488
Mailing Address - Fax:
Practice Address - Street 1:4916 CENTER ST STE G
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2348
Practice Address - Country:US
Practice Address - Phone:253-912-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60927978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist