Provider Demographics
NPI:1053709345
Name:HARRIS, REBECCA LANELLE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LANELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WHITESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-2626
Mailing Address - Country:US
Mailing Address - Phone:843-729-1605
Mailing Address - Fax:
Practice Address - Street 1:1248 N LONGSTREET ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-2748
Practice Address - Country:US
Practice Address - Phone:843-354-7529
Practice Address - Fax:843-382-7542
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3394224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant