Provider Demographics
NPI:1134435753
Name:FISHER, SAMANTHA J (MSOTR/L)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N TULPEHOCKEN ST
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-1204
Mailing Address - Country:US
Mailing Address - Phone:570-527-5905
Mailing Address - Fax:
Practice Address - Street 1:1000 SCHUYLKILL MANOR RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3862
Practice Address - Country:US
Practice Address - Phone:570-622-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011253225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist