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General NPI Number Information
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NPI Number | 1174364046
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Entity Type | Individual
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Provider Name | WILLIAM POTOCNIK OTR/L
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Gender | Male
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 08/03/2024
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Provider Practice Location Address
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Address Line | 799 W BOYLSTON ST STE 7
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City | WORCESTER
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State | MA
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Zip | 01606-3071
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Country | US
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Telephone | 617-738-5110
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Fax |
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Provider Business Mailing Address
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Address Line | 270 N BROOKFIELD RD
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City | BARRE
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State | MA
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Zip | 01005-9186
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Country | US
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Telephone | 487-287-8472
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTL15380
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License Number State | MA
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