Basic Information
| Provider Information | |||||||||
| NPI: | 1396233979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | ANTRIM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034403709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035882246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 RIVERMEAD RD | ||||||||
| Address2: | |||||||||
| City: | PETERBOROUGH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034581788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039240062 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2018 | ||||||||
| LastUpdateDate: | 04/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0615 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.