Provider Demographics
NPI:1336415785
Name:BISHOP, JACOB A (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:A
Last Name:BISHOP
Suffix:
Gender:M
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 1:2237 E CATHY CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3942
Mailing Address - Country:US
Mailing Address - Phone:480-603-6995
Mailing Address - Fax:
Practice Address - Street 1:2237 E CATHY CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3942
Practice Address - Country:US
Practice Address - Phone:480-603-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist