MEDICARE: CAROL HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227900000X	Registered Respiratory Therapist	RT12114	FL

General Provider Information

NPI Number	:	1205278728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL HARRIS

Provider Business Mailing Address
First Line	:	PO BOX 103
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32170-0103
Country	:	US
Telephone Number	:	386-847-8768
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 OLIVER DR
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-8240
Country	:	US
Telephone Number	:	386-847-8768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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Directions to “ CAROL HARRIS ” Practice Location

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