Provider Demographics
NPI:1427089820
Name:HARBAUGH, CHRISTOPHER S (OTRL)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:S
Last Name:HARBAUGH
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 12TH ST NORTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-253-7257
Mailing Address - Fax:320-251-2938
Practice Address - Street 1:3701 12TH ST NORTH
Practice Address - Street 2:SUITE 100
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-253-7257
Practice Address - Fax:320-251-2938
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100368225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
55B12HAOtherBCBS
670000090OtherMETRAHEALTH MPIN
1027606OtherP ONE
6401838OtherMEDICA
P00064404OtherRAILROAD MEDICARE
MN1043238843Medicare NSC