Provider Demographics
NPI:1326758988
Name:FISHER, KAITLYNN NOEL (CPO)
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:NOEL
Last Name:FISHER
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W TRADE ST APT 427
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3822
Mailing Address - Country:US
Mailing Address - Phone:717-514-2563
Mailing Address - Fax:
Practice Address - Street 1:1041 HAWTHORNE LN STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2915
Practice Address - Country:US
Practice Address - Phone:704-333-4700
Practice Address - Fax:704-333-4707
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist