Provider Demographics
NPI:1801770342
Name:BOTTS, MEGAN ELISE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:BOTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FAWN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-3669
Mailing Address - Country:US
Mailing Address - Phone:864-378-3567
Mailing Address - Fax:
Practice Address - Street 1:12 FAWN VALLEY LN
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-3669
Practice Address - Country:US
Practice Address - Phone:864-378-3567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program