Healthcare Provider Details

I. General information

NPI: 1427669118
Provider Name (Legal Business Name): MS. ELIZABETH CHRISTINE HOTTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 VISTA CT
CHARLES TOWN WV
25414-3803
US

IV. Provider business mailing address

209 VISTA CT
CHARLES TOWN WV
25414-3803
US

V. Phone/Fax

Practice location:
  • Phone: 304-724-9977
  • Fax:
Mailing address:
  • Phone: 240-687-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: