Healthcare Provider Details

I. General information

NPI: 1841015724
Provider Name (Legal Business Name): ELENA N BISHOP OTD, OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 200
GRESHAM OR
97030-3723
US

IV. Provider business mailing address

831 NW COUNCIL DR STE 200
GRESHAM OR
97030-3723
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-1876
  • Fax:
Mailing address:
  • Phone: 503-492-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number449903
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: