Provider Demographics
NPI:1750115689
Name:BOTTI, KYLE EDWARD
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:EDWARD
Last Name:BOTTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HOLYOKE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2346
Mailing Address - Country:US
Mailing Address - Phone:413-313-7738
Mailing Address - Fax:
Practice Address - Street 1:320 RIVERSIDE DR STE 9
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-2750
Practice Address - Country:US
Practice Address - Phone:413-313-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist