Provider Demographics
NPI:1326218777
Name:BARTLEY, DENNIS G (COTA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:G
Last Name:BARTLEY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 S HERMAN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2850
Mailing Address - Country:US
Mailing Address - Phone:414-732-4730
Mailing Address - Fax:
Practice Address - Street 1:3130 S HERMAN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2850
Practice Address - Country:US
Practice Address - Phone:414-732-4730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1988-027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist