Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 WOODY HAYES DR # 2210
COLUMBUS OH
43210-1103
US

IV. Provider business mailing address

1350 KING AVE APT 204
COLUMBUS OH
43212-2234
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-4154
  • Fax:
Mailing address:
  • Phone: 970-846-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: