Provider Demographics
NPI:1962688572
Name:HARPER, JEANNE M (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:HARPER
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 LAKE DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:PORTOLA
Mailing Address - State:CA
Mailing Address - Zip Code:96122-8012
Mailing Address - Country:US
Mailing Address - Phone:530-832-0834
Mailing Address - Fax:
Practice Address - Street 1:7332 LAKE DAVIS RD
Practice Address - Street 2:
Practice Address - City:PORTOLA
Practice Address - State:CA
Practice Address - Zip Code:96122-8012
Practice Address - Country:US
Practice Address - Phone:530-832-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4725225XH1200X
NV0625225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABD610Medicare PIN
NVV110270Medicare PIN