MEDICARE: MS. BERNADETTE ANN GATES OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	056.006590	IL

General Provider Information

NPI Number	:	1881895787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERNADETTE ANN GATES OTR

Provider Business Mailing Address
First Line	:	416 MCHENRY AVE
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7147
Country	:	US
Telephone Number	:	815-260-0131
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 NORTHWEST HWY
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8058
Country	:	US
Telephone Number	:	847-842-4167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	04/01/2009

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