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General NPI Number Information
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NPI Number | 1942654074
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Entity Type | Individual
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Provider Name | PROF. FELICIA HARRIS
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Gender | Female
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1923 N HANLEY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63114-6309
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Country | US
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Telephone | 314-504-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 SAINT VINCENT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63104-2028
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Country | US
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Telephone | 314-504-6466
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | LC0665509
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License Number State | MO
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