Provider Demographics
NPI:1902588239
Name:FISH, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MARION ST
Mailing Address - Street 2:
Mailing Address - City:MEADOWLAKES
Mailing Address - State:TX
Mailing Address - Zip Code:78654-6403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 HOSPITAL LOOP NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2115
Practice Address - Country:US
Practice Address - Phone:503-348-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT-2024-0017225X00000X
OR353041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist