Provider Demographics
NPI:1023177060
Name:PHILIP, MICHAEL FRANK (OTRL)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANK
Last Name:PHILIP
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 SOUTH 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514
Mailing Address - Country:US
Mailing Address - Phone:760-872-3757
Mailing Address - Fax:760-872-1643
Practice Address - Street 1:151 PIONEER LANE
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514
Practice Address - Country:US
Practice Address - Phone:760-872-1000
Practice Address - Fax:760-872-1643
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 7054225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist