Healthcare Provider Details

I. General information

NPI: 1386507358
Provider Name (Legal Business Name): GREGORY COLE POTTER OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FARRELL DR
COVINGTON KY
41011-3785
US

IV. Provider business mailing address

3854 ALEX CT APT 5
COVINGTON KY
41017-8304
US

V. Phone/Fax

Practice location:
  • Phone: 443-892-0104
  • Fax:
Mailing address:
  • Phone: 606-495-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number297440
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: