Healthcare Provider Details

I. General information

NPI: 1265068829
Provider Name (Legal Business Name): LOTUS INTEGRATIVE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 WEST STREET SUITE #112 LOTUS INTEGRATIVE THERAPY
MARLEMONT OH
45227
US

IV. Provider business mailing address

3814 WEST STREET SUITE #112 LOTUS INTEGRATIVE THERAPY
MARLEMONT OH
45227
US

V. Phone/Fax

Practice location:
  • Phone: 773-259-4786
  • Fax: 513-327-2036
Mailing address:
  • Phone: 773-259-4786
  • Fax: 513-327-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. INGRID ELIZABETH KEATING
Title or Position: OWNER (ACUPUNCTURIST & OCCUPATIONAL
Credential: L. AC., OTR/L
Phone: 773-259-4786