Provider Demographics
NPI:1912230301
Name:FISHER, REBECCA L (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 GUNDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8624
Mailing Address - Country:US
Mailing Address - Phone:607-227-4421
Mailing Address - Fax:607-463-0602
Practice Address - Street 1:15 CATHERWOOD RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1071
Practice Address - Country:US
Practice Address - Phone:607-227-4421
Practice Address - Fax:607-463-0602
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013428225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04303086Medicaid