Provider Demographics
NPI:1912412479
Name:FISHER, KIMBERLY KAY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:1225 OAKDALE RD RM 169
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3357
Mailing Address - Country:US
Mailing Address - Phone:209-557-6200
Mailing Address - Fax:209-557-6203
Practice Address - Street 1:1225 OAKDALE RD RM 169
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3357
Practice Address - Country:US
Practice Address - Phone:209-557-6200
Practice Address - Fax:209-557-6203
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15935225XG0600X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology