Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1427320787 |
---|---|
Provider Name | Annette B Bottum |
First Address | Ypsilanti, MI 48197-6827 |
Second Address | Ypsilanti, MI 48197-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2012 |
Last Update Date | 05/04/2012 |