Healthcare Provider Details

I. General information

NPI: 1346088259
Provider Name (Legal Business Name): MICKAYLA BOTTOMS ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N K ST
TULARE CA
93274-4005
US

IV. Provider business mailing address

209 N K ST
TULARE CA
93274-4005
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-7616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW124118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: