Healthcare Provider Details

I. General information

NPI: 1275661217
Provider Name (Legal Business Name): KARLY ANNE FISHER OTR-L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLY ANNE ACKERMANN OTR-L

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 E HENRY AVE
TAMPA FL
33610-4434
US

IV. Provider business mailing address

2403 E HENRY AVE
TAMPA FL
33610-4434
US

V. Phone/Fax

Practice location:
  • Phone: 813-988-7633
  • Fax:
Mailing address:
  • Phone: 813-988-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: