MEDICARE: TERRY LYN FISHER

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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1053174839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY LYN FISHER

Provider Business Mailing Address
First Line	:	703 W SOUTH ST
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-2044
Country	:	US
Telephone Number	:	419-953-7968
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 W SOUTH ST
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-2044
Country	:	US
Telephone Number	:	419-953-7968
Fax Number	:

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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Directions to “ TERRY LYN FISHER ” Practice Location

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