Provider Demographics
NPI:1861767865
Name:MBOTE, DOROTHEA PAULETTE
Entity type:Individual
Prefix:MRS
First Name:DOROTHEA
Middle Name:PAULETTE
Last Name:MBOTE
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 1:9836 ARAGORN LN NW
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6993
Mailing Address - Country:US
Mailing Address - Phone:704-948-5290
Mailing Address - Fax:
Practice Address - Street 1:9836 ARAGORN LN NW
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6993
Practice Address - Country:US
Practice Address - Phone:704-948-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist