Provider Demographics
NPI:1811142128
Name:FISHER, DENISE A (ATC, PTA, LMT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:FISHER
Suffix:
Gender:F
Credentials:ATC, PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W GRAND VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORWELL
Mailing Address - State:OH
Mailing Address - Zip Code:44076-9437
Mailing Address - Country:US
Mailing Address - Phone:440-226-0073
Mailing Address - Fax:
Practice Address - Street 1:111 GRAND VALLEY AVE WEST
Practice Address - Street 2:
Practice Address - City:ORWELL
Practice Address - State:OH
Practice Address - Zip Code:44076-9452
Practice Address - Country:US
Practice Address - Phone:440-437-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0030962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer