Provider Demographics
NPI:1679941769
Name:FITCH, OFELIA (LMT)
Entity type:Individual
Prefix:MRS
First Name:OFELIA
Middle Name:
Last Name:FITCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E MAIN AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1723
Mailing Address - Country:US
Mailing Address - Phone:616-510-0396
Mailing Address - Fax:
Practice Address - Street 1:109 E MAIN AVE
Practice Address - Street 2:STE 4
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1723
Practice Address - Country:US
Practice Address - Phone:616-510-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL525646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist