Provider Demographics
NPI:1295934560
Name:BISHOP, HEATHER R (OTR)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:BISHOP
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CREEKVIEW CT STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4839
Mailing Address - Country:US
Mailing Address - Phone:864-286-9966
Mailing Address - Fax:864-286-9933
Practice Address - Street 1:1 CREEKVIEW CT STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4839
Practice Address - Country:US
Practice Address - Phone:864-286-9966
Practice Address - Fax:864-286-9933
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1421225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1421OtherSC LICENSE