Provider Demographics
NPI:1366951634
Name:BISHOP, HEATHER LORINE (TSC/COTA)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LORINE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:TSC/COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 69TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-5850
Mailing Address - Country:US
Mailing Address - Phone:941-306-4113
Mailing Address - Fax:
Practice Address - Street 1:1414 69TH AVE W FL 34207
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5850
Practice Address - Country:US
Practice Address - Phone:941-306-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA1189224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant