Provider Demographics
NPI:1194207019
Name:BATES, CAROLINE SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SUE
Last Name:BATES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:SUE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:502 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1426
Mailing Address - Country:US
Mailing Address - Phone:573-218-9991
Mailing Address - Fax:
Practice Address - Street 1:502 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1426
Practice Address - Country:US
Practice Address - Phone:573-218-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist