Provider Demographics
NPI:1396580668
Name:LITTLE FISH OT
Entity type:Organization
Organization Name:LITTLE FISH OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SERVICE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:661-858-3219
Mailing Address - Street 1:16 ALICE FARR DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-1502
Mailing Address - Country:US
Mailing Address - Phone:661-858-3219
Mailing Address - Fax:
Practice Address - Street 1:16 ALICE FARR DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-1502
Practice Address - Country:US
Practice Address - Phone:661-858-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty