Provider Demographics
NPI:1790438562
Name:FISHER, LAUREN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 JENKINS BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT ULLA
Mailing Address - State:NC
Mailing Address - Zip Code:28125-8699
Mailing Address - Country:US
Mailing Address - Phone:704-798-4879
Mailing Address - Fax:877-991-7837
Practice Address - Street 1:1086 JENKINS BRANCH LN
Practice Address - Street 2:
Practice Address - City:MOUNT ULLA
Practice Address - State:NC
Practice Address - Zip Code:28125-8699
Practice Address - Country:US
Practice Address - Phone:704-798-4879
Practice Address - Fax:877-991-7837
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist