Individual
MRS. JANETTE LUANNE FISKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
294 W CARLOS AVE, HOLBROOK, AZ 86025-1846
(928) 524-2123
(928) 524-6367
Mailing address
294 W CARLOS AVE, HOLBROOK, AZ 86025-1846
(928) 524-2123
(928) 524-6367
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1723
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284312
—
AZ
Enumeration date
01/14/2008
Last updated
01/14/2008
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