Provider Demographics
NPI:1225546039
Name:BISHOW-SEMEVOLOS, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BISHOW-SEMEVOLOS
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 1:66 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-2513
Mailing Address - Country:US
Mailing Address - Phone:631-805-3561
Mailing Address - Fax:
Practice Address - Street 1:66 SOUTH RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-2513
Practice Address - Country:US
Practice Address - Phone:631-805-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001791221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist