Provider Demographics
NPI:1457846172
Name:LOTTON, TARA J (RBT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:J
Last Name:LOTTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 RADNOR LN
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1906
Mailing Address - Country:US
Mailing Address - Phone:708-603-9054
Mailing Address - Fax:
Practice Address - Street 1:66 RADNOR LN
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1906
Practice Address - Country:US
Practice Address - Phone:708-603-9054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL334728056106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician