Provider Demographics
NPI:1124201488
Name:BATES, MARIA J (BA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:BATES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WAREHAM ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6221
Mailing Address - Country:US
Mailing Address - Phone:617-803-0842
Mailing Address - Fax:
Practice Address - Street 1:5 WAREHAM ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6221
Practice Address - Country:US
Practice Address - Phone:617-803-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist