1578746830 NPI number — MS. SUSAN DORENE FISHER OT ASST

Table of content: MS. SUSAN DORENE FISHER OT ASST (NPI 1578746830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578746830 NPI number — MS. SUSAN DORENE FISHER OT ASST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
SUSAN
Provider Middle Name:
DORENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OT ASST
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:
1578746830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 337
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDICAL LAKE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-299-6488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2219 N 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHENEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-235-6196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2007

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: 224Z00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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