MEDICARE: STACY APRIL LOTT M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1790970689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY APRIL LOTT M.S.

Provider Business Mailing Address
First Line	:	810 FOXWORTH BLVD APT 209
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-4858
Country	:	US
Telephone Number	:	773-895-1495
Fax Number	:

Provider Business Practice Location Address
First Line	:	3828 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-4027
Country	:	US
Telephone Number	:	773-826-1916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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