MEDICARE: TOBY 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	103TR0400X	Rehabilitation Psychologist	082152968	OK

General Provider Information

NPI Number	:	1710315882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOBY FISHER

Provider Business Mailing Address
First Line	:	3913 HARTLINE DR
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3913 HARTLINE DR
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4305
Country	:	US
Telephone Number	:	405-623-8639
Fax Number	:

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

Provider Enumeration Date	:	10/28/2013
Last Update Date	:	10/28/2013

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Directions to “ TOBY FISHER ” Practice Location

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