Provider Demographics
NPI:1043350986
Name:FISH, GRETCHEN LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LYNN
Last Name:FISH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 SOARING BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-2603
Mailing Address - Country:US
Mailing Address - Phone:571-224-3322
Mailing Address - Fax:850-469-0858
Practice Address - Street 1:916 E FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2817
Practice Address - Country:US
Practice Address - Phone:850-434-7755
Practice Address - Fax:850-469-0858
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 16772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist