Provider Demographics
NPI:1982806659
Name:GILLOTTI, CYNTHIA M (CRC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:GILLOTTI
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 ZENGEL DR.
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-435-4740
Mailing Address - Fax:937-435-4741
Practice Address - Street 1:174 ZENGEL DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-4450
Practice Address - Country:US
Practice Address - Phone:937-435-4740
Practice Address - Fax:937-435-4741
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00011317171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator