Provider Demographics
NPI:1982040838
Name:HARRISON, BICHELLE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:BICHELLE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FERNLEY ST
Mailing Address - Street 2:PO BOX 457
Mailing Address - City:WHITESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08252
Mailing Address - Country:US
Mailing Address - Phone:609-513-0523
Mailing Address - Fax:609-465-2196
Practice Address - Street 1:1300 FERNLEY ST
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08252-0457
Practice Address - Country:US
Practice Address - Phone:609-513-0523
Practice Address - Fax:609-465-2196
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00512100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist