Provider Demographics
NPI:1952327371
Name:BOTT, LYNN C (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:C
Last Name:BOTT
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3322
Mailing Address - Country:US
Mailing Address - Phone:785-843-8078
Mailing Address - Fax:
Practice Address - Street 1:618 8TH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-6009
Practice Address - Country:US
Practice Address - Phone:785-594-8424
Practice Address - Fax:785-594-8465
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00002-242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS00002-24OtherATHLETIC TRAINER