Healthcare Provider Details

I. General information

NPI: 1083158562
Provider Name (Legal Business Name): DAWN FISCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 CUMBERLAND AVE
PORTLAND ME
04101-2957
US

IV. Provider business mailing address

46 LONGFELLOW ST
PORTLAND ME
04103-4423
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-8100
  • Fax:
Mailing address:
  • Phone: 201-228-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2854
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: