Audrey Bottomly, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

101943 Issued in AK

Practice address

546 N Main St
Wasilla, AK 99654-7019

Phone

(907) 376-2600

Fax

(907) 376-2605

NPI assigned

May 19, 2016

Last updated

May 19, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stanley Health Clinics PC

  dba Back and Neck Pain Relief Center of Wasilla

  • Chiropractor
  • Wasilla, AK
  • NPI 1891828786
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463616000000",
    "number": "1285081166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "546 N MAIN ST",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547019",
            "telephone_number": "907-376-2600",
            "fax_number": "907-376-2605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "546 N MAIN ST",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547019",
            "telephone_number": "907-376-2600",
            "fax_number": "907-376-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTOMLY",
        "first_name": "AUDREY",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-19",
        "last_updated": "2016-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AK",
            "license": "101943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OCCUPATIONAL LICENSE",
            "identifier": "101943",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Inna Borteychuk
• Todd Bosen
• Boston Consults of Alaska, LLC
• John Cecil Boston, D.O.
• Amberly Dawn Boswell
• Jamie Bottoms
• Angelina Bethany Bourasaw
• Heather Anne Bourasaw
• Alyssa Bourdukofsky
• Jennifer Bourne

• Massage Therapist in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Massage Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.