Provider Demographics
NPI:1801830351
Name:FISCHER, MARY J (OTR)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:FISCHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:4848 S 76TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4361
Practice Address - Country:US
Practice Address - Phone:414-282-5610
Practice Address - Fax:414-282-5601
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1064-026225XH1200X
WI1064225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40871700Medicaid
WI1801830351Medicaid
WI01994-0355Medicare PIN
WI40871700Medicaid