Provider Demographics
NPI:1427320787
Name:BOTTUM, ANNETTE B
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:B
Last Name:BOTTUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 NUTMEG DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6827
Mailing Address - Country:US
Mailing Address - Phone:315-440-1998
Mailing Address - Fax:734-879-2774
Practice Address - Street 1:50 N HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2608
Practice Address - Country:US
Practice Address - Phone:734-340-6914
Practice Address - Fax:734-879-2774
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter