Healthcare Provider Details

I. General information

NPI: 1952327371
Provider Name (Legal Business Name): LYNN C. BOTT MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 8TH ST
BALDWIN CITY KS
66006-6009
US

IV. Provider business mailing address

3613 PARKVIEW CT
LAWRENCE KS
66049-3322
US

V. Phone/Fax

Practice location:
  • Phone: 785-594-8424
  • Fax: 785-594-8465
Mailing address:
  • Phone: 785-843-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00002-24
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: