Provider Demographics
NPI:1124112875
Name:KATES, MARY BETH (ATC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:KATES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:BENTONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39040-9073
Mailing Address - Country:US
Mailing Address - Phone:205-746-3113
Mailing Address - Fax:
Practice Address - Street 1:520 HIGGINS RD
Practice Address - Street 2:
Practice Address - City:BENTONIA
Practice Address - State:MS
Practice Address - Zip Code:39040-9073
Practice Address - Country:US
Practice Address - Phone:205-746-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT00742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSAT0074OtherMISSISSIPPI STATE LICENSE
029402501OtherNATABOC
MSAT0074OtherMISSISSIPPI STATE LICENSE