Provider Demographics
NPI:1598407165
Name:BOTTOMLY-COX, SARAH KATHERINE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHERINE
Last Name:BOTTOMLY-COX
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 1:6653 MCLOUGHLIN DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9448
Mailing Address - Country:US
Mailing Address - Phone:541-499-5626
Mailing Address - Fax:
Practice Address - Street 1:700 E MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7158
Practice Address - Country:US
Practice Address - Phone:541-499-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023487225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist