Provider Demographics
NPI:1841385481
Name:BISHOP, ROBERT (OT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BISHOP
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16325
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-6325
Mailing Address - Country:US
Mailing Address - Phone:601-296-9191
Mailing Address - Fax:601-296-9190
Practice Address - Street 1:16 OFFICE PARK DRIVE
Practice Address - Street 2:SUITE 21
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-296-9191
Practice Address - Fax:601-296-9190
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0493225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03389700Medicaid
MSP00062876OtherRAILROAD MEDICARE