Healthcare Provider Details

I. General information

NPI: 1073873998
Provider Name (Legal Business Name): SAMANTHA GLEN HALL-FISHER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W LINCOLN RD SUITE B
KOKOMO IN
46902-3850
US

IV. Provider business mailing address

315 W LINCOLN RD SUITE B
KOKOMO IN
46902-3850
US

V. Phone/Fax

Practice location:
  • Phone: 765-614-1217
  • Fax:
Mailing address:
  • Phone: 765-614-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: