Provider Demographics
NPI:1821226762
Name:FISK, TINA MARIE RUMBY (OTR/L)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE RUMBY
Last Name:FISK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 W JOMAX RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-8643
Mailing Address - Country:US
Mailing Address - Phone:480-593-6933
Mailing Address - Fax:623-388-3998
Practice Address - Street 1:3108 W JOMAX RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-8643
Practice Address - Country:US
Practice Address - Phone:480-593-6933
Practice Address - Fax:623-388-3998
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0132225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist