Provider Demographics
NPI:1588184352
Name:FISHER, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MADISON PLACE CIR APT MM
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-9002
Mailing Address - Country:US
Mailing Address - Phone:717-682-2349
Mailing Address - Fax:
Practice Address - Street 1:706 NORTHEAST DR STE 1
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7423
Practice Address - Country:US
Practice Address - Phone:980-231-1959
Practice Address - Fax:704-909-4070
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15731225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist