Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 004209-1 | NY |
NPI | 1013150291 |
---|---|
Provider Name | Ms. Christine M Potter |
First Address | Fort Plain, NY 13339-1350 |
Second Address | Fort Plain, NY 13339-1350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 17/04/2009 |