Provider Demographics
NPI:1861412249
Name:HARRISON, HILDA (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:HILDA
Middle Name:
Last Name:HARRISON
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 1:12276 SAN JOSE BLVD
Mailing Address - Street 2:STE. 508
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8628
Mailing Address - Country:US
Mailing Address - Phone:904-886-3228
Mailing Address - Fax:904-886-3297
Practice Address - Street 1:12276 SAN JOSE BLVD
Practice Address - Street 2:STE. 508
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8628
Practice Address - Country:US
Practice Address - Phone:904-886-3228
Practice Address - Fax:904-886-3297
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11373225XP0200X
FLOT 11373225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889923100Medicaid
FLZ076AOtherBCBS