Provider Demographics
NPI:1891089215
Name:FISCHER, MARY MARGARET (CPO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:FISCHER
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 IRONWOOD PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2662
Mailing Address - Country:US
Mailing Address - Phone:208-765-0597
Mailing Address - Fax:208-765-0598
Practice Address - Street 1:2204 IRONWOOD PL
Practice Address - Street 2:SUITE A
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2662
Practice Address - Country:US
Practice Address - Phone:208-765-0597
Practice Address - Fax:208-765-0598
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI60177376222Z00000X
WAPS60177307224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist