Provider Demographics
NPI:1912153495
Name:HARRIS, MICHELE RENEA (ORT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENEA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-3934
Mailing Address - Country:US
Mailing Address - Phone:479-633-0326
Mailing Address - Fax:479-633-0326
Practice Address - Street 1:826 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-3934
Practice Address - Country:US
Practice Address - Phone:479-633-0326
Practice Address - Fax:479-633-0326
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist