Provider Demographics
NPI:1265095848
Name:BOTTORFF, ANDREA LEIGH
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEIGH
Last Name:BOTTORFF
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 1:310 PRALL RD
Mailing Address - Street 2:
Mailing Address - City:HENRYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47126-9743
Mailing Address - Country:US
Mailing Address - Phone:502-931-8735
Mailing Address - Fax:
Practice Address - Street 1:310 PRALL RD
Practice Address - Street 2:
Practice Address - City:HENRYVILLE
Practice Address - State:IN
Practice Address - Zip Code:47126-9743
Practice Address - Country:US
Practice Address - Phone:502-931-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist