MEDICARE: MRS. ANGELA DAWN FISHER OTRL

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	225XP0200X	Pediatric Occupational Therapist	OTR1529	AR

General Provider Information

NPI Number	:	1194861294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA DAWN FISHER OTRL

Provider Business Mailing Address
First Line	:	8103 BEAR HOLLOW RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-7416
Country	:	US
Telephone Number	:	479-996-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	8103 BEAR HOLLOW RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-7416
Country	:	US
Telephone Number	:	479-996-0124
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/16/2023

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