Provider Demographics
NPI:1083509285
Name:HARLEY, NATHAN MICHAEL
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:HARLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MARSHALL AVE STE 908
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4824
Mailing Address - Country:US
Mailing Address - Phone:800-994-5403
Mailing Address - Fax:
Practice Address - Street 1:312 MARSHALL AVE STE 908
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4824
Practice Address - Country:US
Practice Address - Phone:800-994-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor