Provider Demographics
NPI:1497355531
Name:BOTERF, JAN CARRIE
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:CARRIE
Last Name:BOTERF
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 1:2873 ROAD 250A
Mailing Address - Street 2:
Mailing Address - City:ANTWERP
Mailing Address - State:OH
Mailing Address - Zip Code:45813-9610
Mailing Address - Country:US
Mailing Address - Phone:419-506-1594
Mailing Address - Fax:
Practice Address - Street 1:2873 ROAD 250A
Practice Address - Street 2:
Practice Address - City:ANTWERP
Practice Address - State:OH
Practice Address - Zip Code:45813-9610
Practice Address - Country:US
Practice Address - Phone:419-506-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care