Provider Demographics
NPI:1376955377
Name:BATO, EDWIN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:BATO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 NIGHTSCAPE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1618
Mailing Address - Country:US
Mailing Address - Phone:904-234-0875
Mailing Address - Fax:
Practice Address - Street 1:3434 NIGHTSCAPE CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1618
Practice Address - Country:US
Practice Address - Phone:904-234-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10110314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility