Provider Demographics
NPI:1811404197
Name:FISHER, JOHN LUTHER
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LUTHER
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4108
Mailing Address - Country:US
Mailing Address - Phone:413-729-4140
Mailing Address - Fax:
Practice Address - Street 1:266 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4108
Practice Address - Country:US
Practice Address - Phone:413-729-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist