Provider Demographics
NPI:1841489689
Name:HARRIS, BERNICE ELIZABETH (DI)
Entity type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:ELIZABETH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5875 MEADOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKHOLDS
Mailing Address - State:KY
Mailing Address - Zip Code:40759-9791
Mailing Address - Country:US
Mailing Address - Phone:606-404-0091
Mailing Address - Fax:606-539-9489
Practice Address - Street 1:5875 MEADOW CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKHOLDS
Practice Address - State:KY
Practice Address - Zip Code:40759-9791
Practice Address - Country:US
Practice Address - Phone:606-404-0091
Practice Address - Fax:606-539-9489
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY383845676222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist