Provider Demographics
NPI:1346714706
Name:LOTT, GREW GRACE (ATC)
Entity Type:Individual
Prefix:MS
First Name:GREW
Middle Name:GRACE
Last Name:LOTT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:DAWSON
Other - Middle Name:THOMAS
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3318 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144
Mailing Address - Country:US
Mailing Address - Phone:419-707-4481
Mailing Address - Fax:
Practice Address - Street 1:12839 W PORTAGE RIVER SOUTH RD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-9687
Practice Address - Country:US
Practice Address - Phone:419-707-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer