Provider Demographics
NPI:1457603144
Name:FISTER, CARRIE L (AT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:FISTER
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BUCHTEL MALL
Mailing Address - Street 2:INFOCISION STADIUM 307G
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44325-5103
Mailing Address - Country:US
Mailing Address - Phone:330-972-8499
Mailing Address - Fax:330-972-5293
Practice Address - Street 1:302 BUCHTEL MALL
Practice Address - Street 2:INFOCISION STADIUM 307G
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44325-5103
Practice Address - Country:US
Practice Address - Phone:330-972-8499
Practice Address - Fax:330-972-5293
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0017542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer