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General NPI Number Information
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NPI Number | 1023555372
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Entity Type | Individual
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Provider Name | MADELYN JOY BATES MOT
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Gender | Female
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 5538 W AUER AVE
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City | MILWAUKEE
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State | WI
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Zip | 53216-3132
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Country | US
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Telephone | 305-308-9571
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Fax |
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Provider Business Mailing Address
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Address Line | 5538 W AUER AVE
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City | MILWAUKEE
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State | WI
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Zip | 53216-3132
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Country | US
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Telephone | 305-308-9571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 16238
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 07345
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5975 - 26
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License Number State | WI
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