Provider Demographics
NPI:1104061035
Name:FISCHER, TAWANA MELISSA (OTR/L, ATP)
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:MELISSA
Last Name:FISCHER
Suffix:
Gender:F
Credentials:OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3611
Mailing Address - Country:US
Mailing Address - Phone:732-423-4339
Mailing Address - Fax:
Practice Address - Street 1:81 HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3611
Practice Address - Country:US
Practice Address - Phone:732-423-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012874225X00000X
NJ46TR00436100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012874OtherNEW YORK STATE EDUCATION DEPARTMENT OCCUPATIONAL THERAPY LICENSE
NJ46TR00436100OtherNEW JERSEY OFFICE OF ATTORNEY GENERAL DIVISION OF CONSUMER AFFAIRS OT ADV COUNCI