Provider Demographics
NPI:1770778649
Name:HARRIS, TANISHA RENEE (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:TANISHA
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1212
Mailing Address - Country:US
Mailing Address - Phone:804-539-8567
Mailing Address - Fax:
Practice Address - Street 1:806 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-1212
Practice Address - Country:US
Practice Address - Phone:804-539-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004611225X00000X
VA0119004302225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist