Healthcare Provider Details

I. General information

NPI: 1316621477
Provider Name (Legal Business Name): SOPHIA DEVOSS HARRISON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 WESTGATE PKWY STE 7
DOTHAN AL
36303-2154
US

IV. Provider business mailing address

1308 GARRISON AVE
PORT ST JOE FL
32456-1622
US

V. Phone/Fax

Practice location:
  • Phone: 334-268-5880
  • Fax:
Mailing address:
  • Phone: 850-227-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number123604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: