Basic Information
| Provider Information | |||||||||
| NPI: | 1497796171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6151 ISLAND RD | ||||||||
| Address2: | |||||||||
| City: | JARREAU | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707493100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256276340 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8080 BLUEBONNET BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708107827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254087995 | ||||||||
| FaxNumber: | 2254087989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Z20093 | LA | Y | Other Service Providers | Specialist |
No ID Information.