Provider Demographics
NPI:1821494485
Name:FISHER, ANN MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-9301
Mailing Address - Country:US
Mailing Address - Phone:812-838-6554
Mailing Address - Fax:812-838-9685
Practice Address - Street 1:1415 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-9301
Practice Address - Country:US
Practice Address - Phone:812-838-6554
Practice Address - Fax:812-838-9685
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002721A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant