MEDICARE: DAVID AARON LOTTMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1033674957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID AARON LOTTMAN

Provider Business Mailing Address
First Line	:	2860 FALCONHILL DR
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-2443
Country	:	US
Telephone Number	:	407-413-6789
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 S 8TH ST STE 120
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-6700
Country	:	US
Telephone Number	:	407-413-6789
Fax Number	:	321-445-9760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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