Provider Demographics
NPI:1376730077
Name:BISHOP, SUSAN DIANE (MSTRS/CKT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MSTRS/CKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 BOBWHITE TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2305
Mailing Address - Country:US
Mailing Address - Phone:405-623-4017
Mailing Address - Fax:
Practice Address - Street 1:2835 BOBWHITE TRL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-2305
Practice Address - Country:US
Practice Address - Phone:405-623-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist