Provider Demographics
NPI:1306253174
Name:HARRIS, KATHRYN J (ATC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:144 GRIDLEYVILLE CROSSING RD
Mailing Address - Street 2:APT 4
Mailing Address - City:WILLSEYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13864-1526
Mailing Address - Country:US
Mailing Address - Phone:315-243-9374
Mailing Address - Fax:
Practice Address - Street 1:144 GRIDLEYVILLE CROSSING RD
Practice Address - Street 2:APT 4
Practice Address - City:WILLSEYVILLE
Practice Address - State:NY
Practice Address - Zip Code:13864-1526
Practice Address - Country:US
Practice Address - Phone:315-243-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002059-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer