Provider Demographics
NPI:1124356100
Name:BOTELER, BOBBI HITCHCOCK (RD)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:HITCHCOCK
Last Name:BOTELER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 HANOVER PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2021
Mailing Address - Country:US
Mailing Address - Phone:301-474-2499
Mailing Address - Fax:301-474-5943
Practice Address - Street 1:9881 BROKENLAND PKWY
Practice Address - Street 2:STE 105
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1172
Practice Address - Country:US
Practice Address - Phone:301-474-2499
Practice Address - Fax:301-474-5943
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2704133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered