Provider Demographics
NPI:1043856271
Name:BISHOP, VALERIE LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 ROUTE 19 UNIT 6
Mailing Address - Street 2:
Mailing Address - City:ELIZAVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12523-1132
Mailing Address - Country:US
Mailing Address - Phone:518-929-3369
Mailing Address - Fax:
Practice Address - Street 1:649 ROUTE 19 UNIT 6
Practice Address - Street 2:
Practice Address - City:ELIZAVILLE
Practice Address - State:NY
Practice Address - Zip Code:12523-1132
Practice Address - Country:US
Practice Address - Phone:518-929-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009920224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant