Healthcare Provider Details

I. General information

NPI: 1992423834
Provider Name (Legal Business Name): SHILO LOTTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E 14TH AVE APT F
COLUMBUS OH
43201-1944
US

IV. Provider business mailing address

270 E 14TH AVE APT F
COLUMBUS OH
43201-1944
US

V. Phone/Fax

Practice location:
  • Phone: 970-846-2505
  • Fax:
Mailing address:
  • Phone: 970-846-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: