Healthcare Provider Details

I. General information

NPI: 1013775386
Provider Name (Legal Business Name): EMILY HARRIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S BEDFORD ST STE 101W
BURLINGTON MA
01803-5152
US

IV. Provider business mailing address

30 COLLINS AVE APT 414
SAUGUS MA
01906-1066
US

V. Phone/Fax

Practice location:
  • Phone: 617-865-9445
  • Fax:
Mailing address:
  • Phone: 508-564-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number15165
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: