Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 302002 | OR |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 8459499-4201 | UT |
NPI | 1235561176 |
---|---|
Provider Name | Miss Marla Fisher |
First Address | Lyndeborough, NH 03082 |
Second Address | Lyndeborough, NH 03082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2013 |
Last Update Date | 02/08/2013 |