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General NPI Number Information
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NPI Number | 1487110847
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Entity Type | Individual
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Provider Name | COREY JAMAL LOTT
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Gender | Male
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 1604 CAVALIER BLVD
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City | PONTAMOUTH
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State | VA
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Zip | 23701
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Country | US
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Telephone | 757-297-9086
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 CAVALIER BLVD
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City | PONTAMOUTH
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State | VA
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Zip | 23701
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Country | US
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Telephone | 757-297-9086
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374T00000X
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Taxonomy Name | Religious Nonmedical Nursing Personnel
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number |
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License Number State |
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