MEDICARE: MAKALA ROSE FISHER BCBA, LBA

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	103K00000X	Behavior Analyst	1-20-43540	VA
2	106S00000X	Behavior Technician	RBT-17-39493	WA
3	106S00000X	Behavior Technician	00003894	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0133004551	OTHER	VA	COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
2	1-20-43540	OTHER	VA	BEHAVIOR ANALYST CERTIFICATION BOARD

General Provider Information

NPI Number	:	1497255129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKALA ROSE FISHER BCBA, LBA

Provider Business Mailing Address
First Line	:	12201 GAYTON RD STE 103
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-8203
Country	:	US
Telephone Number	:	804-610-2332
Fax Number	:

Provider Business Practice Location Address
First Line	:	12201 GAYTON RD STE 103
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-8203
Country	:	US
Telephone Number	:	804-610-2332
Fax Number	:

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

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	04/07/2026

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