Provider Demographics
NPI:1760830970
Name:BOTARD, SHALYN
Entity Type:Individual
Prefix:
First Name:SHALYN
Middle Name:
Last Name:BOTARD
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 1:3411 DIVISION DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-5789
Mailing Address - Country:US
Mailing Address - Phone:417-257-9152
Mailing Address - Fax:417-257-9162
Practice Address - Street 1:3411 DIVISION DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-5789
Practice Address - Country:US
Practice Address - Phone:417-257-9152
Practice Address - Fax:417-257-9162
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other