Provider Demographics
NPI:1053988790
Name:BILLOTTI, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BILLOTTI
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 1:5734 FORCE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVE
Mailing Address - State:OH
Mailing Address - Zip Code:44676-9777
Mailing Address - Country:US
Mailing Address - Phone:330-465-4166
Mailing Address - Fax:
Practice Address - Street 1:5734 FORCE RD
Practice Address - Street 2:
Practice Address - City:SHREVE
Practice Address - State:OH
Practice Address - Zip Code:44676-9777
Practice Address - Country:US
Practice Address - Phone:330-465-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8502076Medicaid