Healthcare Provider Details

I. General information

NPI: 1164201562
Provider Name (Legal Business Name): OM FISHER HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 WESTVIEW MEADOWS RD
MONTPELIER VT
05602-3385
US

IV. Provider business mailing address

171 WESTVIEW MEADOWS RD
MONTPELIER VT
05602-3385
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-1068
  • Fax:
Mailing address:
  • Phone: 802-223-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DAWN PALOWSKI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 802-223-1068