Individual
TRACEY BATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1778 FOUNTAIN DR, RESTON, VA 20190-3390
(571) 926-9398
Mailing address
579 LEGACY PRIDE DR, HERNDON, VA 20170-5041
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
0119005224
VA
225X00000X
Occupational Therapist
Primary
6423
AL
Other
Enumeration date
06/11/2014
Last updated
09/23/2024
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