Healthcare Provider Details

I. General information

NPI: 1275456733
Provider Name (Legal Business Name): ANKE MICHAELA KOTTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANKE MICHAELA YOUNG

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MAIN ST
BUFFALO WY
82834-1814
US

IV. Provider business mailing address

517 N ADAMS AVE
BUFFALO WY
82834-1714
US

V. Phone/Fax

Practice location:
  • Phone: 406-570-8799
  • Fax:
Mailing address:
  • Phone: 406-570-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-11736
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: