Provider Demographics
NPI:1306985775
Name:FISHER, LAURA MARY (OTR)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARY
Last Name:FISHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SUTRO FOREST DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19215 PENINSULA SHORES DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-7579
Practice Address - Country:US
Practice Address - Phone:703-501-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7008225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12442285OtherCAQH
NC175CMOtherBCBS
VA314668OtherAMERIGROUP
NC7302425Medicaid
VA187840OtherBLUE CROSS BLUE SHIELD
0560OtherCIGNA
853461OtherOPTUMHEALTH