Individual provider Active NPI

Kristin Marie Harris, OTR/L

  • Occupational Therapist
  • Jackson, MI
National Provider Identifier
1639935752
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5201012715 Issued in MI
Practice address
1001 Laurence Ave Ste E
Jackson, MI 49202-2980
Phone
(517) 750-4777
NPI assigned
Feb 26, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5201012715 MI Primary

Addresses

Primary practice location

1001 Laurence Ave Ste E
Jackson, MI 49202-2980

Mailing address

1001 Laurence Ave Ste E
Jackson, MI 49202-2980
Phone (517) 750-4777

Other names 1

  • Kristin Marie Elliott Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5201012715MIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Speech and Therapy Center, Inc CurrentSince Mar 3, 2024 Accepting new patients
Comprehensive Speech and Therapy Center, Inc PastSince Mar 3, 2024 Accepting new patients

Locations

1001 Laurence Ave
Ste E
Jackson, MI 49202
Phone (517) 750-4777

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1639935752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 LAURENCE AVE STE E",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022980",
            "telephone_number": "517-750-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 LAURENCE AVE STE E",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022980",
            "telephone_number": "517-750-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "KRISTIN",
        "middle_name": "MARIE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201012715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "ELLIOTT",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.