Provider Demographics
NPI:1528465176
Name:GAIL HARRISS
Entity type:Organization
Organization Name:GAIL HARRISS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O,T,
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRISS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:951-659-3267
Mailing Address - Street 1:PO BOX 3318
Mailing Address - Street 2:
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-3318
Mailing Address - Country:US
Mailing Address - Phone:951-659-3267
Mailing Address - Fax:951-659-3267
Practice Address - Street 1:54699 MARION VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:IDYLLWILD
Practice Address - State:CA
Practice Address - Zip Code:92549
Practice Address - Country:US
Practice Address - Phone:951-659-3267
Practice Address - Fax:951-659-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1646224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty