Provider Demographics
NPI:1508982521
Name:HARLESS, MARIA S
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:S
Last Name:HARLESS
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 1:407 FARMER RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-9509
Mailing Address - Country:US
Mailing Address - Phone:417-742-0930
Mailing Address - Fax:417-742-0841
Practice Address - Street 1:WILLARD R-II SCHOOLS
Practice Address - Street 2:407 FARMER RD
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9509
Practice Address - Country:US
Practice Address - Phone:417-742-0930
Practice Address - Fax:417-742-0841
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO488232919Medicaid