Provider Demographics
NPI:1306944343
Name:FISHER, NANCY SELDON (OT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SELDON
Last Name:FISHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2112
Mailing Address - Country:US
Mailing Address - Phone:319-398-1793
Mailing Address - Fax:319-558-4055
Practice Address - Street 1:600 7TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2112
Practice Address - Country:US
Practice Address - Phone:319-398-1793
Practice Address - Fax:319-558-4055
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00210225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IAIB1212Medicare PIN
IAIB1213Medicare PIN
IAIB1212026Medicare PIN
IAIB1213026Medicare PIN