Individual
STEPHANIE BOTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBA, LAT, ACT
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(331) 262-5587
Mailing address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002227A
IN
Other
Enumeration date
03/08/2016
Last updated
12/05/2024
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