MEDICARE: MR. MICHAEL BOTTOMLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225CA2400X	Assistive Technology Practitioner Rehabilitation Counselor

General Provider Information

NPI Number	:	1881712792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL BOTTOMLEY

Provider Business Mailing Address
First Line	:	6055 E WASHINGTON BLVD
Second Line	:	SUITE 900
City	:	COMMERCE
State	:	CA
Zip	:	90040-2418
Country	:	US
Telephone Number	:	323-346-0960
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 ORANGE AVE APT 5
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5616
Country	:	US
Telephone Number	:	323-346-0960
Fax Number	:	323-346-0966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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