Provider Demographics
NPI:1912445396
Name:BOTSFORD, LOU ANN (LMT)
Entity Type:Individual
Prefix:
First Name:LOU ANN
Middle Name:
Last Name:BOTSFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7293 POST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3212
Mailing Address - Country:US
Mailing Address - Phone:401-486-9113
Mailing Address - Fax:401-383-6065
Practice Address - Street 1:7293 POST RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3212
Practice Address - Country:US
Practice Address - Phone:401-486-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT01387172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker