Provider Demographics
NPI:1811502487
Name:HARRIS, SEASON ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:SEASON
Middle Name:ELIZABETH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30900 GREEN BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8346
Mailing Address - Country:US
Mailing Address - Phone:951-385-7597
Mailing Address - Fax:
Practice Address - Street 1:6659 KIMBALL DR STE D403
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5141
Practice Address - Country:US
Practice Address - Phone:253-851-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21281225X00000X
WA61074607225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist