Provider Demographics
NPI:1942783188
Name:FISHER, LINDSEY RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RAE
Last Name:FISHER
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 1:79 BIRCH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5404
Mailing Address - Country:US
Mailing Address - Phone:207-692-7736
Mailing Address - Fax:
Practice Address - Street 1:19 GENERAL MOORE WAY
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1860
Practice Address - Country:US
Practice Address - Phone:207-667-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3544225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist