Provider Demographics
NPI:1518797901
Name:LOTZ, ALISHA ANN
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:ANN
Last Name:LOTZ
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 1:315 YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-3571
Mailing Address - Country:US
Mailing Address - Phone:937-570-7674
Mailing Address - Fax:
Practice Address - Street 1:315 YOUNG ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-3571
Practice Address - Country:US
Practice Address - Phone:937-570-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X, 347C00000X, 347E00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant