MEDICARE: MR. TIMOTHY PAUL FISCUS MSR, CCC-SLP

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	235Z00000X	Speech-Language Pathologist	3841	SC

General Provider Information

NPI Number	:	1780834317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY PAUL FISCUS MSR, CCC-SLP

Provider Business Mailing Address
First Line	:	2508 MELVILLE RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9798
Country	:	US
Telephone Number	:	843-810-3933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 MELVILLE RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9798
Country	:	US
Telephone Number	:	843-810-3933
Fax Number	:

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

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	09/19/2008

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