Provider Demographics
NPI:1992240832
Name:HARRIS, TA'NIQUA JESSICA (MOTR/L)
Entity type:Individual
Prefix:
First Name:TA'NIQUA
Middle Name:JESSICA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:TA'NIQUA
Other - Middle Name:JESSICA
Other - Last Name:NEWKIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 CORPORATE CENTER CT STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3839
Mailing Address - Country:US
Mailing Address - Phone:336-967-1649
Mailing Address - Fax:336-276-1728
Practice Address - Street 1:7 CORPORATE CENTER CT STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3839
Practice Address - Country:US
Practice Address - Phone:336-967-1649
Practice Address - Fax:336-276-1728
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18169225X00000X
SC5819225X00000X
NC377218225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20JDAOtherBCBS NC
NC1548836406Medicaid