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General NPI Number Information
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NPI Number | 1790969855
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Entity Type | Organization
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Legal Business Name | SCOTT FISHER
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 231 CO. HWY 1
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City | BAINBRIDGE
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State | NY
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Zip | 13733
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Country | US
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Telephone | 607-433-0829
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Fax | 607-433-0829
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Provider Business Mailing Address
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Address Line | PO BOX 292
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City | SIDNEY
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State | NY
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Zip | 13838-0292
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Country | US
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Telephone | 607-433-0829
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Fax | 607-433-0829
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Authorized Official
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Title or Position | OWNER
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Name | MR. SCOTT ALAN FISHER
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Credential | CF, PTA
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Telephone | 607-433-0829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | C16086
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | C16086
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License Number State | NY
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