Provider Demographics
NPI:1558186122
Name:HOTTLE, JOHNATHAN LUKE
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:LUKE
Last Name:HOTTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WAYBRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-7382
Mailing Address - Country:US
Mailing Address - Phone:304-490-5255
Mailing Address - Fax:
Practice Address - Street 1:410 WAYBRIGHT LN
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-7382
Practice Address - Country:US
Practice Address - Phone:304-490-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency