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NPI Code Detail

MEDICARE: MRS. CAROL GRAY POTTER OTR/L, BCG, CAPS

MEDICARE: MRS. CAROL GRAY POTTER OTR/L, BCG, CAPS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XG0600XGerontology Occupational Therapist1963WA
2225XG0600XGerontology Occupational Therapist6281CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10153392OTHERWALABOR & INDUSTRIES
20373POOTHERWAREGENCE BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952304875
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROL GRAY POTTER OTR/L, BCG, CAPS
Provider Business Mailing Address
First Line : 21 CANDLEWOOD LN
Second Line :
City : MADISON
State : CT
Zip : 06443-1914
Country : US
Telephone Number : 425-478-6098
Fax Number : 425-977-7193
Provider Business Practice Location Address
First Line : 21 CANDLEWOOD LN
Second Line :
City : MADISON
State : CT
Zip : 06443-1914
Country : US
Telephone Number : 425-478-6098
Fax Number : 425-977-7193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 08/13/2024

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