Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 0119002858 | VA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 0119002858 | VA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 0119002858 | VA |
NPI | 1033324231 |
---|---|
Provider Name | Mrs. Ivy Cecilia Bishop- St. Ange |
First Address | Stafford, VA 22556-3652 |
Second Address | Stafford, VA 22554-7246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |