Provider Demographics
NPI:1427108174
Name:BOTTS, BARBARA MICHELLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:MICHELLE
Last Name:BOTTS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:B
Other - Middle Name:MICHELLE
Other - Last Name:JESSOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3918 IRWIN SIMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9754
Mailing Address - Country:US
Mailing Address - Phone:513-545-7134
Mailing Address - Fax:513-398-2382
Practice Address - Street 1:3918 IRWIN SIMPSON ROAD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9754
Practice Address - Country:US
Practice Address - Phone:513-545-7134
Practice Address - Fax:513-398-2382
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13921225700000X
KY1167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH16175935000OtherWORKMANS COMP PROVIDER