Provider Demographics
NPI:1558529594
Name:BOTT, HEATHER RAE (CPTA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RAE
Last Name:BOTT
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KS
Mailing Address - Zip Code:66080-4021
Mailing Address - Country:US
Mailing Address - Phone:785-835-6135
Mailing Address - Fax:
Practice Address - Street 1:340 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KS
Practice Address - Zip Code:66080-4021
Practice Address - Country:US
Practice Address - Phone:785-835-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01930225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant