Healthcare Provider Details

I. General information

NPI: 1235476789
Provider Name (Legal Business Name): STACIE FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6281 TRI RIDGE BLVD STE 100
LOVELAND OH
45140-8345
US

IV. Provider business mailing address

6281 TRI RIDGE BLVD STE 100
LOVELAND OH
45140-8345
US

V. Phone/Fax

Practice location:
  • Phone: 866-791-5766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-4873
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: