Provider Demographics
NPI:1962846477
Name:HARRISS, GAIL MONTEE (BA,BS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MONTEE
Last Name:HARRISS
Suffix:
Gender:F
Credentials:BA,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54699 MARION VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549
Mailing Address - Country:US
Mailing Address - Phone:951-659-3267
Mailing Address - Fax:951-659-3267
Practice Address - Street 1:11650 PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6536
Practice Address - Country:US
Practice Address - Phone:951-488-0404
Practice Address - Fax:951-488-0404
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAOT 6564225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174400000XOther Service ProvidersSpecialist