Provider Demographics
NPI:1477725729
Name:OTT, JOSEPH L (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:OTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3533
Mailing Address - Country:US
Mailing Address - Phone:419-207-1085
Mailing Address - Fax:
Practice Address - Street 1:1522 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3533
Practice Address - Country:US
Practice Address - Phone:419-207-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094645208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics