Provider Demographics
NPI:1538167556
Name:FISHER, JILL L (OT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:L
Other - Last Name:LEFEVRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7575 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4346
Mailing Address - Country:US
Mailing Address - Phone:513-233-4360
Mailing Address - Fax:513-233-4361
Practice Address - Street 1:7575 5 MILE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4346
Practice Address - Country:US
Practice Address - Phone:513-233-4360
Practice Address - Fax:513-233-4361
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT02430225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000353162OtherANTHEM
OH9384476OtherPHCS
OH0090321Medicaid
OHP00728506OtherMEDICARE RAILROAD
OH000000353162OtherANTHEM
Q35266Medicare UPIN
OH0225920002Medicare NSC