Individual
BREANNE BATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
4121 KING RD, SYLVANIA, OH 43560-4438
(419) 517-8200
Mailing address
4121 KING RD, SYLVANIA, OH 43560-4438
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
006980
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006980
—
OH
Enumeration date
03/31/2015
Last updated
03/31/2015
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