Healthcare Provider Details

I. General information

NPI: 1033428404
Provider Name (Legal Business Name): JENNIFER L BISHOP OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COMMONS DR # F SUITE 38
LONDONDERRY NH
03053-3441
US

IV. Provider business mailing address

1 COMMONS DR # F SUITE 38
LONDONDERRY NH
03053-3441
US

V. Phone/Fax

Practice location:
  • Phone: 603-437-3330
  • Fax: 603-437-0431
Mailing address:
  • Phone: 603-437-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0607
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: