Healthcare Provider Details

I. General information

NPI: 1003592130
Provider Name (Legal Business Name): TAMMY FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 S EWING ST
LANCASTER OH
43130-9405
US

IV. Provider business mailing address

734 S EWING ST
LANCASTER OH
43130-9405
US

V. Phone/Fax

Practice location:
  • Phone: 740-652-5191
  • Fax:
Mailing address:
  • Phone: 740-652-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number6401718
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: