Provider Demographics
NPI:1134778459
Name:HARRIS, CARLY ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6643
Mailing Address - Country:US
Mailing Address - Phone:304-312-8038
Mailing Address - Fax:
Practice Address - Street 1:1228 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5787
Practice Address - Country:US
Practice Address - Phone:304-242-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist