Provider Demographics
NPI:1821133851
Name:WOTTON, JEFFREY BRUCE (LAT,C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRUCE
Last Name:WOTTON
Suffix:
Gender:M
Credentials:LAT,C
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Mailing Address - Street 1:1 ELM ST
Mailing Address - Street 2:UNIT #42
Mailing Address - City:BYFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01922-2734
Mailing Address - Country:US
Mailing Address - Phone:978-499-3103
Mailing Address - Fax:978-499-3213
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:UNIT #42
Practice Address - City:BYFIELD
Practice Address - State:MA
Practice Address - Zip Code:01922
Practice Address - Country:US
Practice Address - Phone:978-499-3103
Practice Address - Fax:978-499-3213
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA7542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer