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General NPI Number Information
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NPI Number | 1356634430
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Entity Type | Individual
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Provider Name | JENESSA FISK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 94 MAIN ST
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City | BUXTON
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State | ME
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Zip | 04093
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Country | US
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Telephone | 207-929-3831
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Fax |
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Provider Business Mailing Address
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Address Line | 58 FEDERAL ST APT 1
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City | PORTLAND
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State | ME
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Zip | 04101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | TT60155766
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT2561
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License Number State | ME
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