Provider Demographics
NPI:1699111658
Name:LOTT, HEATHER MICHELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:LOTT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 2ND RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:NE
Mailing Address - Zip Code:68864-2215
Mailing Address - Country:US
Mailing Address - Phone:402-317-0088
Mailing Address - Fax:
Practice Address - Street 1:2802 2ND RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:NE
Practice Address - Zip Code:68864-2215
Practice Address - Country:US
Practice Address - Phone:402-317-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE725224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE224Z00000XMedicaid