Provider Demographics
NPI:1679926133
Name:BOTTMEYER, BRITTANY LAUREN DEMARA (MS, CCC-SLP,LAT, ATC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LAUREN DEMARA
Last Name:BOTTMEYER
Suffix:
Gender:F
Credentials:MS, CCC-SLP,LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 CHEYNEY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2002
Mailing Address - Country:US
Mailing Address - Phone:484-326-6224
Mailing Address - Fax:
Practice Address - Street 1:520 CHEYNEY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2002
Practice Address - Country:US
Practice Address - Phone:484-326-6224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
PART0065892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer