Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC014973 | PA |
NPI | 1962054924 |
---|---|
Provider Name | Timothy M Fisch |
First Address | Scranton, PA 18510-2193 |
Second Address | Scranton, PA 18510-2193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2019 |
Last Update Date | 10/07/2019 |