Provider Demographics
NPI:1912180480
Name:BISHOP, PATRICIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 175TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4610
Mailing Address - Country:US
Mailing Address - Phone:708-957-8326
Mailing Address - Fax:
Practice Address - Street 1:1055 175TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4610
Practice Address - Country:US
Practice Address - Phone:708-957-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker