Provider Demographics
NPI:1851888150
Name:FISHER, MEGAN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:BIBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:5879 S 400 W
Mailing Address - Street 2:
Mailing Address - City:CLAYPOOL
Mailing Address - State:IN
Mailing Address - Zip Code:46510-9455
Mailing Address - Country:US
Mailing Address - Phone:574-371-7335
Mailing Address - Fax:
Practice Address - Street 1:1093 S 250 E
Practice Address - Street 2:
Practice Address - City:WINONA LAKE
Practice Address - State:IN
Practice Address - Zip Code:46590-5703
Practice Address - Country:US
Practice Address - Phone:574-267-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20000260862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer