Provider Demographics
NPI:1619120854
Name:BOTHWELL, PATRICIA PALMER (LMT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:PALMER
Last Name:BOTHWELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 NE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-5312
Mailing Address - Country:US
Mailing Address - Phone:352-425-2328
Mailing Address - Fax:
Practice Address - Street 1:705 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5312
Practice Address - Country:US
Practice Address - Phone:352-425-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 54496171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor