Provider Demographics
NPI:1003902941
Name:BOTTOMLEY, SUSAN GORTHEY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GORTHEY
Last Name:BOTTOMLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 NW PROFESSIONAL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3891
Mailing Address - Country:US
Mailing Address - Phone:541-757-7269
Mailing Address - Fax:541-757-7465
Practice Address - Street 1:2211 NW PROFESSIONAL DR
Practice Address - Street 2:STE 100
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3891
Practice Address - Country:US
Practice Address - Phone:541-757-7269
Practice Address - Fax:541-757-7465
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist