Individual
AMANDA LYN BISHOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4000 LONDON RD, DULUTH, MN 55804-2220
(218) 428-5050
Mailing address
817 N 56TH AVE W, DULUTH, MN 55807-1328
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
MN
Enumeration date
06/22/2017
Last updated
06/22/2017
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