MEDICARE: MS. LAURA EMILY FISHER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	748	OK

General Provider Information

NPI Number	:	1003801762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA EMILY FISHER PHD

Provider Business Mailing Address
First Line	:	415 SE DEWEY
Second Line	:	STE 301
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003
Country	:	US
Telephone Number	:	918-336-7090
Fax Number	:	918-336-8090

Provider Business Practice Location Address
First Line	:	415 SE DEWEY
Second Line	:	STE 301
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003
Country	:	US
Telephone Number	:	918-336-7090
Fax Number	:	918-336-8090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/08/2007

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