Healthcare Provider Details

I. General information

NPI: 1427089820
Provider Name (Legal Business Name): CHRISTOPHER S HARBAUGH OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 12TH ST NORTH SUITE 100
ST CLOUD MN
56303
US

IV. Provider business mailing address

3701 12TH ST NORTH SUITE 100
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-7257
  • Fax: 320-251-2938
Mailing address:
  • Phone: 320-253-7257
  • Fax: 320-251-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number100368
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: