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General NPI Number Information
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NPI Number | 1366318537
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Entity Type | Individual
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Provider Name | JILLIAN GRACE HARRIS
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Gender | Female
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 4301 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7199
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Country | US
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Telephone | 601-686-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 520 MITCHELL ST
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City | CONWAY
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State | AR
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Zip | 72034-5109
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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 | OTR4140
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License Number State | AR
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