Provider Demographics
NPI:1568113678
Name:FISHER, JANINE (COTA)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:
Other - Last Name:HAMPLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:31574 WINTERBERRY PKWY UNIT 309
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3770
Mailing Address - Country:US
Mailing Address - Phone:914-330-7777
Mailing Address - Fax:
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-912-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA03011224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant