Provider Demographics
NPI:1750753562
Name:HARRELSON, KERRI
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:HARRELSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N RIDGEWOOD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3276
Mailing Address - Country:US
Mailing Address - Phone:386-944-7837
Mailing Address - Fax:
Practice Address - Street 1:125 N RIDGEWOOD AVE FL 2
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3276
Practice Address - Country:US
Practice Address - Phone:386-689-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist