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NPI Code Detail

MEDICARE: MRS. ENJOLI A HARRIS MS, OTR/L

MEDICARE: MRS. ENJOLI A HARRIS MS, 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
1225X00000XOccupational TherapistOC011956PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OC011956OTHERPAOCCUPATIONAL THERAPY LICENSE

General Provider Information

NPI Number : 1578814877
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ENJOLI A HARRIS MS, OTR/L
Provider Business Mailing Address
First Line : 7621 WOOLSTON AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19150-2612
Country : US
Telephone Number : 267-240-6752
Fax Number :
Provider Business Practice Location Address
First Line : 850 PAPER MILL RD
Second Line :
City : GLENSIDE
State : PA
Zip : 19038-7833
Country : US
Telephone Number : 215-402-8833
Fax Number : 215-836-4962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2012
Last Update Date : 09/26/2012

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