Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31005618A | IN |
NPI | 1033630694 |
---|---|
Provider Name | Eric Michael Fiscus |
First Address | Russiaville, IN 46979-9796 |
Second Address | Kokomo, IN 46901-4121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2017 |
Last Update Date | 24/08/2017 |