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General NPI Number Information
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NPI Number | 1427320787
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Entity Type | Individual
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Provider Name | ANNETTE B BOTTUM
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Gender | Female
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 50 N HURON ST
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City | YPSILANTI
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State | MI
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Zip | 48197-2608
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Country | US
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Telephone | 734-340-6914
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Fax | 734-879-2774
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Provider Business Mailing Address
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Address Line | 4660 NUTMEG DR
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City | YPSILANTI
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State | MI
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Zip | 48197-6827
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Country | US
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Telephone | 315-440-1998
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Fax | 734-879-2774
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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