Ottavino grew up in Brooklyn, NY after his family moved there from Manhattan when he was young. He graduated from the Berkeley Carroll School in Park Slope, Brooklyn in 2003.(During his days at Berkley he played his summer ball for the Youth Service League.) He also played in the local little league, the 78th Precinct, for which his father is now an umpire. He was drafted by Tampa Bay in the 30th round of the MLB Draft in 2003 but did not sign and attended college at Northeastern University.
Ottavino pitched for Team Italy in the 2009 World Baseball Classic. On May 29, 2010 he made his debut for the Cardinals. Ottavino was removed from the Cardinals' 40-man roster following the 2010 season. Adam was added back on to the Cardinals 40-man roster on November 18, 2011.  On April 3, 2012, the Colorado Rockies claimed Ottavino off of waivers and sent him to their Triple-A affiliate. He was brought back to the majors later that season. Adam currently wears number 0, and is the only pitcher in Major League history to have ever done so.