Provider Demographics
NPI:1558831537
Name:BOTT, LAUREN KIMBERLY (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KIMBERLY
Last Name:BOTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LOMOND CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5957
Mailing Address - Country:US
Mailing Address - Phone:315-724-4286
Mailing Address - Fax:315-724-4170
Practice Address - Street 1:130 LOMOND CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5957
Practice Address - Country:US
Practice Address - Phone:315-724-4286
Practice Address - Fax:315-724-4170
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0437412251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics