Provider Demographics
NPI:1962658468
Name:BATEMAN, KELLY GIBSON
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:GIBSON
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4263 COUNTY ROAD 18
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8131
Mailing Address - Country:US
Mailing Address - Phone:585-394-9423
Mailing Address - Fax:
Practice Address - Street 1:275 PARRISH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1785
Practice Address - Country:US
Practice Address - Phone:585-393-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006822225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics