Healthcare Provider Details

I. General information

NPI: 1730471491
Provider Name (Legal Business Name): TERRI A HARRIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 04/14/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 8TH ST
LIMON CO
80828-1028
US

IV. Provider business mailing address

PO BOX 123
KARVAL CO
80823-0123
US

V. Phone/Fax

Practice location:
  • Phone: 719-760-0041
  • Fax: 719-743-2093
Mailing address:
  • Phone: 719-760-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number1754
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1936
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: