Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 157 | KS |
Y | 103T00000X | Psychologist | 157 | KS |
NPI | 1003937764 |
---|---|
Provider Name | Matthew R Botkin |
First Address | Mission, KS 66202-3234 |
Second Address | Shawnee, KS 66203-3326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 11/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100098010B | (05) | KS |