Provider Demographics
NPI:1891263265
Name:BATES, CORINNE N (RBT)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:N
Last Name:BATES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10313 ABOITE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5435
Mailing Address - Country:US
Mailing Address - Phone:260-459-6010
Mailing Address - Fax:
Practice Address - Street 1:10313 ABOITE CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5435
Practice Address - Country:US
Practice Address - Phone:260-459-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician