Provider Demographics
NPI:1033309745
Name:GATES, CAROLE BETH
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:BETH
Last Name:GATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:BETH
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6283 W MEGAN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5865
Mailing Address - Country:US
Mailing Address - Phone:480-634-4993
Mailing Address - Fax:
Practice Address - Street 1:6283 W MEGAN ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5865
Practice Address - Country:US
Practice Address - Phone:480-634-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-29
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist