MEDICARE: DELANA RUTH-MARIE HARRIS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	33.026360	OH

General Provider Information

NPI Number	:	1285440412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELANA RUTH-MARIE HARRIS LMT

Provider Business Mailing Address
First Line	:	1527 ROSEWOOD BLVD
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-4028
Country	:	US
Telephone Number	:	313-412-5756
Fax Number	:

Provider Business Practice Location Address
First Line	:	1527 ROSEWOOD BLVD
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-4028
Country	:	US
Telephone Number	:	313-412-5756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	12/03/2024

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