Healthcare Provider Details

I. General information

NPI: 1053397448
Provider Name (Legal Business Name): PATRICIA JEANENE HARLAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY HARLAN OTR/L

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 LEES CHAPEL RD
ALBANY KY
42602
US

IV. Provider business mailing address

1048 LEES CHAPEL RD
ALBANY KY
42602
US

V. Phone/Fax

Practice location:
  • Phone: 606-306-1225
  • Fax: 317-780-3745
Mailing address:
  • Phone: 606-306-1225
  • Fax: 317-780-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberR2791
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberR-2791
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: