Provider Demographics
NPI:1073656294
Name:BOTELHO, DAVID (ATC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BOTELHO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WOODS END DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-4731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:158 HARMON DR
Practice Address - Street 2:NORWICH UNIVERSITY
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-1000
Practice Address - Country:US
Practice Address - Phone:802-485-2236
Practice Address - Fax:802-485-2234
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00000282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer