Healthcare Provider Details

I. General information

NPI: 1245752427
Provider Name (Legal Business Name): JENNA BISHOP OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 GREENBAG RD
MORGANTOWN WV
26501-7163
US

IV. Provider business mailing address

6 EDWIN ST
MORGANTOWN WV
26501-8505
US

V. Phone/Fax

Practice location:
  • Phone: 304-291-5661
  • Fax:
Mailing address:
  • Phone: 304-292-0173
  • Fax: 304-292-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1896
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: