Active NPI
Shelly Harris, OTR
- Occupational Therapist
- Fuquay Varina, NC
National Provider Identifier
1841351202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4715
- Practice address
- 1221 Broad St
Fuquay Varina, NC 27526-3602 - Phone
- (828) 265-0309
- NPI assigned
- Dec 12, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4715 | NC | Primary |
Addresses
Primary practice location
1221 Broad St
Fuquay Varina, NC 27526-3602
Mailing address
2633 New Oxford Dr
Apex, NC 27539-8626
Phone (919) 773-9787
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4715 | NC | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Independence Therapy Services Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Assisted Living Facility
- Fuquay Varina, NC
- NPI 1801955208
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841351202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2633 NEW OXFORD DR",
"city": "APEX",
"state": "NC",
"postal_code": "275398626",
"telephone_number": "919-773-9787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 BROAD ST",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275263602",
"telephone_number": "828-265-0309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "SHELLY",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "4715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fuquay Varina, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.