MEDICARE: JOSHUA AARON HARLESS 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	225X00000X	Occupational Therapist	5041	NC
2	225XP0200X	Pediatric Occupational Therapist	5041	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558677807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA AARON HARLESS OTR/L

Provider Business Mailing Address
First Line	:	2064 WALSHTOWN RD
Second Line	:
City	:	BOOMER
State	:	NC
Zip	:	28606-9166
Country	:	US
Telephone Number	:	336-651-8875
Fax Number	:	336-667-0781

Provider Business Practice Location Address
First Line	:	2064 WALSHTOWN RD
Second Line	:
City	:	BOOMER
State	:	NC
Zip	:	28606-9166
Country	:	US
Telephone Number	:	336-651-8875
Fax Number	:	336-667-0781

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

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	09/16/2011

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