Provider Demographics
NPI:1376750711
Name:BISHOP, DENA MARIE
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:MARIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DENA
Other - Middle Name:MARIE
Other - Last Name:PAGANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1504 YORKSHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-6851
Mailing Address - Country:US
Mailing Address - Phone:863-398-5161
Mailing Address - Fax:
Practice Address - Street 1:1818 HARDEN BLVD STE 160
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1824
Practice Address - Country:US
Practice Address - Phone:863-683-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11498225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889639900Medicaid