Healthcare Provider Details

I. General information

NPI: 1558852426
Provider Name (Legal Business Name): ANGELA P HARRIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2062 PATTONS MILL LN
GALAX VA
24333-2397
US

IV. Provider business mailing address

2062 PATTONS MILL LN
GALAX VA
24333-2397
US

V. Phone/Fax

Practice location:
  • Phone: 276-233-3584
  • Fax: 276-744-0071
Mailing address:
  • Phone: 276-233-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7715
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7173
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119002922
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: