Provider Demographics
NPI:1124166020
Name:BATES, SUSAN R (OT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:BATES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 KANIS RD
Mailing Address - Street 2:STE. D-2
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3733
Mailing Address - Country:US
Mailing Address - Phone:501-687-0851
Mailing Address - Fax:501-687-0853
Practice Address - Street 1:11900 KANIS RD
Practice Address - Street 2:STE. D-2
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3733
Practice Address - Country:US
Practice Address - Phone:501-687-0851
Practice Address - Fax:501-687-0853
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1520225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X525OtherBLUE CROSS BLUE SHIELD