Provider Demographics
NPI:1306968912
Name:STOTLER, DONNA THERESA
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:THERESA
Last Name:STOTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:THERESA
Other - Last Name:KAMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3515 FLORENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5409
Mailing Address - Country:US
Mailing Address - Phone:513-661-6981
Mailing Address - Fax:
Practice Address - Street 1:3515 FLORENCE AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5409
Practice Address - Country:US
Practice Address - Phone:513-661-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2693429Medicaid