Provider Demographics
NPI:1124576061
Name:BISBEE, MICHELLE S
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:BISBEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 BEE LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:FL
Mailing Address - Zip Code:32732-9172
Mailing Address - Country:US
Mailing Address - Phone:407-375-9768
Mailing Address - Fax:
Practice Address - Street 1:1290 BEE LN
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:FL
Practice Address - Zip Code:32732-9172
Practice Address - Country:US
Practice Address - Phone:407-375-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9721224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA9721OtherDEPARTMENT F HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE