Individual
KIMBERLY KAY BOTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
103 HIGHWAY 82, ENTERPRISE, OR 97828-6011
(541) 426-4502
Mailing address
PO BOX 268, ENTERPRISE, OR 97828-0268
(541) 426-4502
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
THW000004120
OR
Other
Enumeration date
03/23/2020
Last updated
03/23/2020
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