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General NPI Number Information
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NPI Number | 1013024686
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Entity Type | Individual
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Provider Name | LIDU IVETTE POTTER OT
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/09/2017
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Provider Practice Location Address
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Address Line | 971 VIRGINIA AVE SUITE A
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City | PALM HARBOR
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State | FL
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Zip | 34683-5235
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Country | US
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Telephone | 727-773-2687
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Fax | 727-773-2742
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Provider Business Mailing Address
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Address Line | 2150 ALT 19 STE A
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City | PALM
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State | FL
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Zip | 34683-5363
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Country | US
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Telephone | 727-773-2687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT10194
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License Number State | FL
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