Provider Demographics
NPI:1023555372
Name:BATES, MADELYN JOY (MOT)
Entity Type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:JOY
Last Name:BATES
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MISS
Other - First Name:MADELYN
Other - Middle Name:JOY
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:5538 W AUER AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3132
Mailing Address - Country:US
Mailing Address - Phone:305-308-9571
Mailing Address - Fax:
Practice Address - Street 1:5538 W AUER AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3132
Practice Address - Country:US
Practice Address - Phone:305-308-9571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16238225X00000X
MD07345225X00000X
WI5975 - 26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist