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NPI Code Detail

MEDICARE: KELLY FISCHER

MEDICARE: KELLY FISCHER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1972239820
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY FISCHER
Provider Business Mailing Address
First Line : 310 GLOCHESKI DR
Second Line :
City : MANISTEE
State : MI
Zip : 49660-2639
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11660 CHIPPEWA HWY
Second Line :
City : BEAR LAKE
State : MI
Zip : 49614-9419
Country : US
Telephone Number : 231-655-3146
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2022
Last Update Date : 07/25/2022

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Directions to “ KELLY FISCHER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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