Provider Demographics
NPI:1194319285
Name:HARRISON, AANISE (OTR/L)
Entity type:Individual
Prefix:
First Name:AANISE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MONTEREY RD APT 5
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1373
Mailing Address - Country:US
Mailing Address - Phone:510-467-3656
Mailing Address - Fax:
Practice Address - Street 1:1323 SPALDING FOREST CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5714
Practice Address - Country:US
Practice Address - Phone:510-467-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124641225X00000X
CA22099225X00000X
GAOT008180225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist