Provider Demographics
NPI:1013095074
Name:FITTERER, BARRY
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:FITTERER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FROST LN
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7028
Mailing Address - Country:US
Mailing Address - Phone:504-491-1365
Mailing Address - Fax:
Practice Address - Street 1:4650 W ESPLANADE AVE STE 106
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2765
Practice Address - Country:US
Practice Address - Phone:504-885-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAZ10656OtherLICENSE#