MEDICARE: MR. WILLIAM WEYMOUTH BATES JR. OTR/L

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	225X00000X	Occupational Therapist	5163391-4201	UT

General Provider Information

NPI Number	:	1336483965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM WEYMOUTH BATES JR. OTR/L

Provider Business Mailing Address
First Line	:	7825 S 1800 E
Second Line	:
City	:	SOUTH WEBER
State	:	UT
Zip	:	84405-7704
Country	:	US
Telephone Number	:	801-791-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E 5350 S
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-6931
Country	:	US
Telephone Number	:	801-479-7543
Fax Number	:

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

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2012

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