Provider Demographics
NPI:1700143146
Name:HARRIS, MARY ANN (OTR)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 SWEET HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13807-1172
Mailing Address - Country:US
Mailing Address - Phone:607-544-4640
Mailing Address - Fax:
Practice Address - Street 1:140 COUNTY HIGHWAY 33W
Practice Address - Street 2:SUITE 3
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-4953
Practice Address - Country:US
Practice Address - Phone:607-547-6474
Practice Address - Fax:607-547-6402
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006139-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist