MEDICARE: REBECCA 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	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	2017044641	MO
2	225XP0200X	Pediatric Occupational Therapist	2017044641	MO
3	225X00000X	Occupational Therapist	2017044641	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609371400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA FISHER

Provider Business Mailing Address
First Line	:	6929 WISE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3731
Country	:	US
Telephone Number	:	314-297-8008
Fax Number	:	314-530-0315

Provider Business Practice Location Address
First Line	:	6929 WISE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3731
Country	:	US
Telephone Number	:	314-297-8008
Fax Number	:	314-530-0315

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

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	11/11/2020

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Directions to “ REBECCA FISHER ” Practice Location

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