Provider Demographics
NPI:1174868186
Name:KOTTLER, BRET (LAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:KOTTLER
Suffix:
Gender:M
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 SKIPPACK PIKE
Mailing Address - Street 2:UNIT 2 E
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1211
Mailing Address - Country:US
Mailing Address - Phone:215-327-7826
Mailing Address - Fax:
Practice Address - Street 1:1497 SKIPPACK PIKE
Practice Address - Street 2:UNIT 2 E
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1211
Practice Address - Country:US
Practice Address - Phone:215-327-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist