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General NPI Number Information
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NPI Number | 1649491291
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Entity Type | Individual
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Provider Name | MELISSA HARRIS OTR
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 430 E. 162ND STREET SUITE 246
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473
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Country | US
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Telephone | 708-466-8351
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Fax | 708-201-7468
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Provider Business Mailing Address
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Address Line | 3427 VOLLMER ROAD
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City | FLOSSMOOR
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State | IL
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Zip | 60422
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Country | US
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Telephone | 708-567-1798
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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 | 56007179
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License Number State | IL
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