Provider Demographics
NPI:1902862766
Name:HARRIS, LAURA L (ATC, PHD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ATC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 SPRING RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6188
Mailing Address - Country:US
Mailing Address - Phone:614-419-0148
Mailing Address - Fax:
Practice Address - Street 1:6805 BOBCAT WAY
Practice Address - Street 2:DUBLIN INTEGRATED EDUCATION CENTER 264
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-1407
Practice Address - Country:US
Practice Address - Phone:614-793-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-10502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer