Provider Demographics
NPI:1649566670
Name:KOTT, KERRY (LAC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:KOTT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:KOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28618 S RABER RD
Mailing Address - Street 2:
Mailing Address - City:GOETZVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49736-9364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6105 MEMORIAL HWY
Practice Address - Street 2:SUITE J
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4597
Practice Address - Country:US
Practice Address - Phone:813-833-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2983171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist