Provider Demographics
NPI:1912059601
Name:HARRIS, HEATHER M (LMT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16337 WITTKE CT
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3871
Mailing Address - Country:US
Mailing Address - Phone:503-888-2654
Mailing Address - Fax:503-296-5636
Practice Address - Street 1:10600 SE MCLOUGHLIN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7428
Practice Address - Country:US
Practice Address - Phone:503-888-2654
Practice Address - Fax:503-296-5635
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10713174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist