Provider Demographics
NPI:1053174839
Name:FISHER, TERRY LYN
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYN
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2044
Mailing Address - Country:US
Mailing Address - Phone:419-953-7968
Mailing Address - Fax:
Practice Address - Street 1:703 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2044
Practice Address - Country:US
Practice Address - Phone:419-953-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care