Provider Demographics
NPI:1871867705
Name:FISHER, KARISA BROOK (LMP)
Entity Type:Individual
Prefix:MS
First Name:KARISA
Middle Name:BROOK
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12812 109TH AVENUE CT E APT D
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-5600
Mailing Address - Country:US
Mailing Address - Phone:253-381-5833
Mailing Address - Fax:
Practice Address - Street 1:12812 109TH AVENUE CT E APT D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-5600
Practice Address - Country:US
Practice Address - Phone:253-381-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60116056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist