Healthcare Provider Details

I. General information

NPI: 1417266628
Provider Name (Legal Business Name): SHARON M FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2562 DURHAM DAYTON HWY APT A
DURHAM CA
95938-9654
US

IV. Provider business mailing address

1011 17TH AVENUE
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 530-513-1714
  • Fax:
Mailing address:
  • Phone: 360-355-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA60175077
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA60175077
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60175077
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60175077
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: