Provider Demographics
NPI:1588718613
Name:BOTKIN, LAURA (RPT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:BOTKIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:ERVING
Mailing Address - State:MA
Mailing Address - Zip Code:01344-0032
Mailing Address - Country:US
Mailing Address - Phone:413-774-7988
Mailing Address - Fax:413-773-7322
Practice Address - Street 1:7 BURNHAM ST
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-1841
Practice Address - Country:US
Practice Address - Phone:413-774-7988
Practice Address - Fax:413-773-7322
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
468763OtherTUFTS
000000039351OtherBMC HEALTHNET
MABOY67225OtherBLUE CROSS/BLUE SHIELD
P00307610OtherRAILROAD MEDICARE
0042242OtherNEIGHBORHOOD HEALTH PLAN
MA0376612Medicaid
P00307610OtherRAILROAD MEDICARE