Provider Demographics
NPI:1336438316
Name:BOTTING, ANGELA (MSED)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BOTTING
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8822 SEAMAN RD
Mailing Address - Street 2:
Mailing Address - City:GASPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14067-9442
Mailing Address - Country:US
Mailing Address - Phone:716-807-7266
Mailing Address - Fax:
Practice Address - Street 1:8822 SEAMAN RD
Practice Address - Street 2:
Practice Address - City:GASPORT
Practice Address - State:NY
Practice Address - Zip Code:14067-9442
Practice Address - Country:US
Practice Address - Phone:716-807-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58020872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist