Provider Demographics
NPI:1730201088
Name:FISHER, HEATHER D (LMT, NCMMT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:D
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMT, NCMMT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:SAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:53 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1134
Mailing Address - Country:US
Mailing Address - Phone:419-448-7188
Mailing Address - Fax:419-455-9252
Practice Address - Street 1:100 HOPEWELL AVE
Practice Address - Street 2:FARM BUREAU BLDG
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2636
Practice Address - Country:US
Practice Address - Phone:419-448-7188
Practice Address - Fax:419-455-9252
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10262225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1177OtherNATIONAL CERTIFICATION
OH10262OtherLICENSE MASSAGE THERAPIST