Provider Demographics
NPI:1790156438
Name:BOTTOM, PAUL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BOTTOM
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 STULTS RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3433
Mailing Address - Country:US
Mailing Address - Phone:617-233-5767
Mailing Address - Fax:
Practice Address - Street 1:30 WASHINGTON ST
Practice Address - Street 2:SUITE #300
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1905
Practice Address - Country:US
Practice Address - Phone:339-686-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist