Provider Demographics
NPI:1205181369
Name:BATES, SANDY
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W QUEEN ISABELLA
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2969
Mailing Address - Country:US
Mailing Address - Phone:361-552-0195
Mailing Address - Fax:956-443-3470
Practice Address - Street 1:112 W QUEEN ISABELLA
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578
Practice Address - Country:US
Practice Address - Phone:361-552-0195
Practice Address - Fax:956-443-3470
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114874225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114874OtherSTATE LICENSE