Provider Demographics
NPI:1902240583
Name:BISHOP, JENNIFER MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SEASONS PL NW APT 305
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8580
Mailing Address - Country:US
Mailing Address - Phone:864-993-8229
Mailing Address - Fax:
Practice Address - Street 1:1404 S SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28159-1921
Practice Address - Country:US
Practice Address - Phone:704-633-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4938-27224Z00000X
NC11568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant