MEDICARE: MARLEETA JOYCE HARRIS OTR/L

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	171W00000X	Contractor	R5089	KY
2	225X00000X	Occupational Therapist	132040	KY

General Provider Information

NPI Number	:	1457787301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEETA JOYCE HARRIS OTR/L

Provider Business Mailing Address
First Line	:	3814 GREENWICH RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1616
Country	:	US
Telephone Number	:	502-855-1271
Fax Number	:

Provider Business Practice Location Address
First Line	:	3814 GREENWICH RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1616
Country	:	US
Telephone Number	:	502-855-1271
Fax Number	:

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

Provider Enumeration Date	:	09/24/2013
Last Update Date	:	01/16/2017

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