Provider Demographics
NPI:1699515296
Name:POTTER, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SD
Mailing Address - Zip Code:57473-9321
Mailing Address - Country:US
Mailing Address - Phone:605-377-4640
Mailing Address - Fax:
Practice Address - Street 1:1206 FULTON ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-1926
Practice Address - Country:US
Practice Address - Phone:910-875-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant