MEDICARE: MAYA LOTT IBCLC

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	174N00000X	Lactation Consultant (Non-RN)	L-317127	IL

General Provider Information

NPI Number	:	1255142923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA LOTT IBCLC

Provider Business Mailing Address
First Line	:	3910 WHITE CLOUD DR
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1730
Country	:	US
Telephone Number	:	518-526-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3910 WHITE CLOUD DR
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1730
Country	:	US
Telephone Number	:	518-526-2888
Fax Number	:

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

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/14/2025

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