Provider Demographics
NPI:1467856997
Name:BATES, MONICA LEE (AT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:LEE
Last Name:BATES
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2434
Mailing Address - Country:US
Mailing Address - Phone:419-448-2052
Mailing Address - Fax:419-448-2007
Practice Address - Street 1:310 E MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2434
Practice Address - Country:US
Practice Address - Phone:419-448-2052
Practice Address - Fax:419-448-2007
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0044932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer