1285713529 NPI number — HEATHER L FISHER OTR

Table of content: HEATHER L FISHER OTR (NPI 1285713529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285713529 NPI number — HEATHER L FISHER OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
HEATHER
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285713529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 TIMBER TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMPERIAL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15126-8906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 CUMBERLAND RD
Provider Second Line Business Practice Location Address:
105
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-5447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-364-1886
Provider Business Practice Location Address Fax Number:
412-364-7120
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OC009180 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1017604340002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 204151437 . This is a "HEALTH AMERICA-ASPIRE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1553259 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1017604340001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001908551 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".