Basic Information
| Provider Information | |||||||||
| NPI: | 1023177060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILIP | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | FRANK | ||||||||
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| Credential: | OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 SOUTH 2ND STREET | ||||||||
| Address2: | |||||||||
| City: | BISHOP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608723757 | ||||||||
| FaxNumber: | 7608721643 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 PIONEER LANE | ||||||||
| Address2: | |||||||||
| City: | BISHOP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608721000 | ||||||||
| FaxNumber: | 7608721643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT 7054 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.