Provider Demographics
NPI:1588362727
Name:FISHER, JENNIFER S (OT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
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 1:13616 TUSCON PASS
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-8865
Mailing Address - Country:US
Mailing Address - Phone:919-720-1994
Mailing Address - Fax:
Practice Address - Street 1:13616 TUSCON PASS
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-8865
Practice Address - Country:US
Practice Address - Phone:919-720-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31003231AOtherINDIANA LICENSE