Provider Demographics
NPI:1295994986
Name:HARKNESS, MARY VIRGINIA (COTA/L)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:VIRGINIA
Last Name:HARKNESS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:JENNEY
Other - Middle Name:VIRGINIA
Other - Last Name:WILKIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31 BELCHER ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MA
Mailing Address - Zip Code:01929-1053
Mailing Address - Country:US
Mailing Address - Phone:978-768-6630
Mailing Address - Fax:
Practice Address - Street 1:31 BELCHER ST
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MA
Practice Address - Zip Code:01929-1053
Practice Address - Country:US
Practice Address - Phone:978-768-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2956224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2956OtherCOTA/L LICENSE