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General NPI Number Information
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NPI Number | 1770778649
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Entity Type | Individual
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Provider Name | TANISHA RENEE HARRIS MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/15/2007
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Provider Practice Location Address
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Address Line | 806 LOUISIANA ST
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City | RICHMOND
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State | VA
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Zip | 23231-1212
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Country | US
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Telephone | 804-539-8567
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Fax |
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Provider Business Mailing Address
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Address Line | 806 LOUISIANA ST
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City | RICHMOND
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State | VA
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Zip | 23231-1212
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Country | US
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Telephone | 804-539-8567
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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 | OT004611
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119004302
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License Number State | VA
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