Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.003990 | OH |
NPI | 1003149964 |
---|---|
Provider Name | Vicki Potter |
First Address | Delaware, OH 43015-7046 |
Second Address | North Canton, OH 44720-7137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2009 |
Last Update Date | 10/09/2009 |