Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 15935 | FL |
N | 225XG0600X | Occupational Therapist - Gerontology | 15935 | FL |
NPI | 1912412479 |
---|---|
Provider Name | Kimberly Kay Fisher |
First Address | Modesto, CA 95355-3357 |
Second Address | Modesto, CA 95355-3357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 06/12/2017 |