Provider Demographics
NPI:1801522412
Name:BOTTARI, MOLLIE DEANNE
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:DEANNE
Last Name:BOTTARI
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 1:2689 KAREN CT APT 826
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1244
Mailing Address - Country:US
Mailing Address - Phone:702-556-9853
Mailing Address - Fax:
Practice Address - Street 1:089 S PECOS RD 3600
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-556-9853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician