Provider Demographics
NPI:1891376059
Name:BOTTEMA, ALLISON LYNN
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LYNN
Last Name:BOTTEMA
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 1:64894 148TH ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MN
Mailing Address - Zip Code:55909-8613
Mailing Address - Country:US
Mailing Address - Phone:507-440-4702
Mailing Address - Fax:
Practice Address - Street 1:702 10TH AVE NW
Practice Address - Street 2:
Practice Address - City:DODGE CENTER
Practice Address - State:MN
Practice Address - Zip Code:55927-9172
Practice Address - Country:US
Practice Address - Phone:507-374-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225200000X
MNA2667225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant