Susan Bates

Individual provider Active NPI Occupational Therapy Assistant · Portage, IN

NPI 1891994869 · NPPES record last updated Jul 11, 2007

Key facts

NPI
1891994869
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
32000314A (IN)
Practice address
6040 Lute Rd
Portage, IN 46368-5008
Phone
(219) 763-6858
NPI assigned
Jul 11, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
32000314AINMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 32000314A IN Yes

Addresses

Primary practice location

6040 Lute Rd
Portage, IN 46368-5008

Mailing address

549 N 750W
Hobart, IN 46342
Phone (219) 759-2287

Other providers in Portage, IN

All providers in Portage, IN · Occupational Therapy Assistant in Indiana

Sources for this page

Verify at the official NPI Registry.