Provider Demographics
NPI:1740592211
Name:BATES, BRIDGETTE NEAL (OT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:NEAL
Last Name:BATES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:COUSHATTA
Mailing Address - State:LA
Mailing Address - Zip Code:71019-8164
Mailing Address - Country:US
Mailing Address - Phone:318-560-7300
Mailing Address - Fax:318-932-7946
Practice Address - Street 1:5024 CUT OFF RD STE B
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019-5116
Practice Address - Country:US
Practice Address - Phone:318-560-7300
Practice Address - Fax:318-932-7946
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12038225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist