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General NPI Number Information
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NPI Number | 1407079312
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Entity Type | Organization
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Legal Business Name | DR. KAYE B. OTTER,P.A.
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 8100 PENN AVE S STE 103
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1360
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Country | US
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Telephone | 952-303-5182
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Fax | 952-303-5182
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Provider Business Mailing Address
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Address Line | 8100 PENN AVE S STE 103
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1360
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Country | US
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Telephone | 952-303-5182
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Fax | 952-303-5182
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAYE BRADLEY OTTER
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Credential | D.C.
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Telephone | 612-827-2651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 1763
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License Number State | MN
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