Provider Demographics
NPI:1508572496
Name:BATES, MACY MONTGOMERY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:MONTGOMERY
Last Name:BATES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:ROXANNA
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:300 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1268
Mailing Address - Country:US
Mailing Address - Phone:256-974-1146
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1268
Practice Address - Country:US
Practice Address - Phone:256-974-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5706224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant