Provider Demographics
NPI:1649032160
Name:RESTORE OCCUPATIONAL THERAPY, PLLC
Entity type:Organization
Organization Name:RESTORE OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:OTR,MOT
Authorized Official - Phone:806-789-9659
Mailing Address - Street 1:3514 152ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6306
Mailing Address - Country:US
Mailing Address - Phone:806-789-9659
Mailing Address - Fax:
Practice Address - Street 1:3223 S LOOP 289 STE 315
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1333
Practice Address - Country:US
Practice Address - Phone:806-789-9659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty