Provider Demographics
NPI:1649823329
Name:FISHER, CHARLOTTE ELIN
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELIN
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:C.
Other - Middle Name:ELIN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:143 BUCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687
Mailing Address - Country:US
Mailing Address - Phone:423-772-0161
Mailing Address - Fax:
Practice Address - Street 1:146 BUCK CREEK RD
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687-3497
Practice Address - Country:US
Practice Address - Phone:423-772-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant