Individual
SHASTA FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
600 W NORTH BLVD, LEESBURG, FL 34748-5063
(352) 728-6636
(352) 728-1322
Mailing address
600 W NORTH BLVD, LEESBURG, FL 34748-5063
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 12833
FL
Other
Enumeration date
02/24/2015
Last updated
02/24/2015
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