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General NPI Number Information
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NPI Number | 1760342711
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Entity Type | Individual
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Provider Name | EMMA RYAN FETTERMAN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 28150 LEMOYNE RD
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City | MILLBURY
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State | OH
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Zip | 43447-9747
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Country | US
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Telephone | 419-661-6520
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Fax |
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Provider Business Mailing Address
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Address Line | 28150 LEMOYNE RD
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City | MILLBURY
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State | OH
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Zip | 43447-9747
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | LSP.03155
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License Number State | OH
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