Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 225C00000X | OK |
NPI | 1285982686 |
---|---|
Provider Name | Mr. Matthew O'neil Potter |
First Address | Yukon, OK 73099 |
Second Address | Yukon, OK 73099-3161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2012 |
Last Update Date | 16/08/2012 |