Provider Demographics
NPI:1619468261
Name:BOTTE, TAMMY ANN (MSED)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:ANN
Last Name:BOTTE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DONCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1219
Mailing Address - Country:US
Mailing Address - Phone:631-505-9503
Mailing Address - Fax:
Practice Address - Street 1:56 DONCASTER AVE
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-1219
Practice Address - Country:US
Practice Address - Phone:631-505-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY854730252Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency