Provider Demographics
NPI:1396820221
Name:FISHER, JENNIFER L (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:FRUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:325 RAILROAD ST STE B
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-1062
Practice Address - Country:US
Practice Address - Phone:517-448-2035
Practice Address - Fax:517-448-2113
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist