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General NPI Number Information
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NPI Number | 1134916018
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Entity Type | Individual
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Provider Name | GREGORY ALAN HARRIS OTA
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Gender | Male
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 5345 WYOMING BLVE NE STE. 108
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City | ALBUQUERQUE
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State | NM
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Zip | 87109
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Country | US
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Telephone | 505-537-9906
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Fax | 505-317-2532
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Provider Business Mailing Address
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Address Line | 5345 WYOMING BLVE NE STE. 108
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City | ALBUQERQUE
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State | NM
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Zip | 87109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2025-0056
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License Number State | NM
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