Provider Demographics
NPI:1780340919
Name:HARRIS, ALAN CHARLES I (COTA/L)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:CHARLES
Last Name:HARRIS
Suffix:I
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 NW SHADDEN DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6639
Mailing Address - Country:US
Mailing Address - Phone:503-435-9861
Mailing Address - Fax:
Practice Address - Street 1:2393 NW SHADDEN DR
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6639
Practice Address - Country:US
Practice Address - Phone:503-435-9861
Practice Address - Fax:503-435-9861
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1043550224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant