Healthcare Provider Details

I. General information

NPI: 1801386115
Provider Name (Legal Business Name): WHITNEY HARRIS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 EDINBOROUGH WAY STE 207
EDINA MN
55435-6001
US

IV. Provider business mailing address

1169 MEADOWBROOK RD
ALTADENA CA
91001-3133
US

V. Phone/Fax

Practice location:
  • Phone: 952-204-5523
  • Fax:
Mailing address:
  • Phone: 323-644-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18694
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number107078
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: