Provider Demographics
NPI:1386984193
Name:HARRISON, DRENDA JOAN (LMT)
Entity type:Individual
Prefix:
First Name:DRENDA
Middle Name:JOAN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DRENDA
Other - Middle Name:JOAN
Other - Last Name:HAMRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:324 MILLER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:26288-1065
Mailing Address - Country:US
Mailing Address - Phone:304-847-5682
Mailing Address - Fax:304-847-5608
Practice Address - Street 1:324 MILLER MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288-1065
Practice Address - Country:US
Practice Address - Phone:304-847-5682
Practice Address - Fax:304-847-5608
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2004-1543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist