Healthcare Provider Details

I. General information

NPI: 1487583449
Provider Name (Legal Business Name): LAURA LOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DEXTERDALE RD
PROVIDENCE RI
02906-2707
US

IV. Provider business mailing address

21 DEXTERDALE RD
PROVIDENCE RI
02906-2707
US

V. Phone/Fax

Practice location:
  • Phone: 540-455-4397
  • Fax:
Mailing address:
  • Phone: 540-455-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number202271
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: