Individual
BENJAMIN BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
8254 118TH AVE, LARGO, FL 33773-5017
(727) 541-5304
Mailing address
13236 FAWN LILY DR, RIVERVIEW, FL 33579-0008
(937) 681-0762
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
15-04279
—
225X00000X
Occupational Therapist
Primary
OT20926
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-04279
REGISTERED BEHAVIOR TECHNICIAN
—
Enumeration date
01/02/2018
Last updated
10/09/2020
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