Healthcare Provider Details

I. General information

NPI: 1912310582
Provider Name (Legal Business Name): TRACEY BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 GOVERNMENT BLVD STE 516
MOBILE AL
36693-4363
US

IV. Provider business mailing address

3737 GOVERNMENT BLVD STE 516
MOBILE AL
36693-4363
US

V. Phone/Fax

Practice location:
  • Phone: 646-512-9978
  • Fax: 251-666-7403
Mailing address:
  • Phone: 646-512-9978
  • Fax: 251-666-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6423
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT008668
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: