Provider Demographics
NPI:1992002893
Name:HARVIN, LOIS STANGA (LTR/CTRS)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:STANGA
Last Name:HARVIN
Suffix:
Gender:F
Credentials:LTR/CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 TEMPLE ST SW
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690-9330
Mailing Address - Country:US
Mailing Address - Phone:828-443-5678
Mailing Address - Fax:
Practice Address - Street 1:1607 TEMPLE ST SW
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-9330
Practice Address - Country:US
Practice Address - Phone:828-443-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist