Provider Demographics
NPI:1992423834
Name:LOTTES, SHILO
Entity type:Individual
Prefix:
First Name:SHILO
Middle Name:
Last Name:LOTTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E 14TH AVE APT F
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-1944
Mailing Address - Country:US
Mailing Address - Phone:970-846-2505
Mailing Address - Fax:
Practice Address - Street 1:270 E 14TH AVE APT F
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-1944
Practice Address - Country:US
Practice Address - Phone:970-846-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports