Provider Demographics
NPI:1497898787
Name:GATES, CAROL ANN-RUDER (ATC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN-RUDER
Last Name:GATES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:RUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:514 PARK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-4526
Mailing Address - Country:US
Mailing Address - Phone:517-796-0748
Mailing Address - Fax:
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9701
Practice Address - Country:US
Practice Address - Phone:517-750-6506
Practice Address - Fax:517-750-2745
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer