Provider Demographics
NPI:1831607159
Name:FISH, TONYA JEAN
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:JEAN
Last Name:FISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16288 INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-9016
Mailing Address - Country:US
Mailing Address - Phone:740-498-8757
Mailing Address - Fax:
Practice Address - Street 1:23720 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-9223
Practice Address - Country:US
Practice Address - Phone:740-622-2032
Practice Address - Fax:740-622-0832
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist