Provider Demographics
NPI:1972743177
Name:FISHER, TODD ERIC (COTA)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ERIC
Last Name:FISHER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 MANHATTAN AVE
Mailing Address - Street 2:4R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2363
Mailing Address - Country:US
Mailing Address - Phone:917-548-3100
Mailing Address - Fax:
Practice Address - Street 1:820 MANHATTAN AVE
Practice Address - Street 2:4R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2363
Practice Address - Country:US
Practice Address - Phone:917-548-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004494-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant