Provider Demographics
NPI:1538358791
Name:HARRISON, JONATHAN DENNIS (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DENNIS
Last Name:HARRISON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:JON
Other - Middle Name:DENNIS
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:210 S 11TH AVE STE 41
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3221
Mailing Address - Country:US
Mailing Address - Phone:509-388-6118
Mailing Address - Fax:
Practice Address - Street 1:210 S 11TH AVE STE 41
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3221
Practice Address - Country:US
Practice Address - Phone:509-388-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT3353225X00000X, 225XE1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand