MEDICARE: MR. ROBERT FISHMAN OTR/L

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	225X00000X	Occupational Therapist	12625	CA

General Provider Information

NPI Number	:	1437480878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT FISHMAN OTR/L

Provider Business Mailing Address
First Line	:	12411 SLAUSON AVE.
Second Line	:	UNIT H.
City	:	WHITTIER
State	:	CA
Zip	:	90606-2835
Country	:	US
Telephone Number	:	562-693-5449
Fax Number	:	562-693-5469

Provider Business Practice Location Address
First Line	:	12411 SLAUSON AVE.
Second Line	:	UNIT H.
City	:	WHITTIER
State	:	CA
Zip	:	90606-2835
Country	:	US
Telephone Number	:	562-693-5449
Fax Number	:	562-693-5469

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

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	09/06/2012

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