Provider Demographics
NPI:1720264740
Name:BISHOP, LESLIE JOAN
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JOAN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:JOAN
Other - Last Name:DEDRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:5601 PLUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1801
Mailing Address - Country:US
Mailing Address - Phone:806-351-1000
Mailing Address - Fax:806-351-8148
Practice Address - Street 1:5601 PLUM CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1801
Practice Address - Country:US
Practice Address - Phone:806-351-1000
Practice Address - Fax:806-351-8148
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106937225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist