Provider Demographics
NPI:1851014690
Name:HARLAN, JAN MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MARIE
Last Name:HARLAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22110 SANDALWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4119
Mailing Address - Country:US
Mailing Address - Phone:281-507-8069
Mailing Address - Fax:
Practice Address - Street 1:2755 CHESTNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2497
Practice Address - Country:US
Practice Address - Phone:281-507-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant