Provider Demographics
NPI:1225638190
Name:BOTTOMS, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BOTTOMS
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 1:5811 GOLDEN BELL WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2268
Mailing Address - Country:US
Mailing Address - Phone:513-863-3242
Mailing Address - Fax:
Practice Address - Street 1:5811 GOLDEN BELL WAY
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-2268
Practice Address - Country:US
Practice Address - Phone:513-863-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care