Provider Demographics
NPI:1205111705
Name:HARPER, KRISTEN LEIGH
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEIGH
Last Name:HARPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-7747
Mailing Address - Country:US
Mailing Address - Phone:941-201-2328
Mailing Address - Fax:
Practice Address - Street 1:30 DAWN AVE
Practice Address - Street 2:
Practice Address - City:FOUR OAKS
Practice Address - State:NC
Practice Address - Zip Code:27524-7747
Practice Address - Country:US
Practice Address - Phone:941-201-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8061224Z00000X
FL11253224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11253OtherSTATE LICENSE
NC8061OtherSTATE LICENSE