Provider Demographics
NPI:1700116944
Name:OTT, SAMUEL JAMES I (RTR)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JAMES
Last Name:OTT
Suffix:I
Gender:M
Credentials:RTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FM 145
Mailing Address - Street 2:
Mailing Address - City:EARTH
Mailing Address - State:TX
Mailing Address - Zip Code:79031-2110
Mailing Address - Country:US
Mailing Address - Phone:806-946-6280
Mailing Address - Fax:
Practice Address - Street 1:350 FM 145
Practice Address - Street 2:
Practice Address - City:EARTH
Practice Address - State:TX
Practice Address - Zip Code:79031-2110
Practice Address - Country:US
Practice Address - Phone:806-946-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97853247100000X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist