Provider Demographics
NPI:1427479286
Name:BATES, ICLEIA NYARI (COTA)
Entity type:Individual
Prefix:
First Name:ICLEIA
Middle Name:NYARI
Last Name:BATES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10368 PANAMA ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10368 PANAMA ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-4529
Practice Address - Country:US
Practice Address - Phone:954-821-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 12314224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant