MEDICARE: MS. CHEYANNE HARRISON

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	225X00000X	Occupational Therapist	005707	GA

General Provider Information

NPI Number	:	1417470378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHEYANNE HARRISON

Provider Business Mailing Address
First Line	:	4024 PRINCETON LAKES WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5528
Country	:	US
Telephone Number	:	404-488-1927
Fax Number	:

Provider Business Practice Location Address
First Line	:	4024 PRINCETON LAKES WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5528
Country	:	US
Telephone Number	:	404-488-1927
Fax Number	:

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

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/21/2022

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