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General NPI Number Information
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NPI Number | 1942818513
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Entity Type | Individual
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Provider Name | JAMES CODY BOTHE
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Gender | Male
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 415 S FEDERAL HWY
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-4931
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Country | US
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Telephone | 866-411-3096
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Fax |
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Provider Business Mailing Address
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Address Line | 13046 52ND CT N
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-8168
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Country | US
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Telephone | 561-255-5895
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SW17425
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License Number State | FL
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