Individual
BRADLEY WILLIAM OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 ABRAHAM FLEXNER WAY, ANESTHESIA DEPARTMENT, LOUISVILLE, KY 40202-2877
(502) 587-4404
(502) 587-4156
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 587-4404
(502) 587-4156
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3004551
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200512440A
—
IN
05
—
74009945
—
KY
Enumeration date
06/27/2006
Last updated
04/05/2018
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