Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CX0006X | Orientation and Mobility Training Provider |
NPI | 1821508060 |
---|---|
Provider Name | Benjamin Fischer |
First Address | Fort Wayne, IN 46805-5100 |
Second Address | Fort Wayne, IN 46805-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2017 |
Last Update Date | 02/10/2017 |