Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.200315 | LA |
NPI | 1023368982 |
---|---|
Provider Name | Loren Fisher |
First Address | Summit, MS 39666-9132 |
Second Address | Oak Grove, LA 71263-8894 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2012 |
Last Update Date | 18/09/2012 |