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General NPI Number Information
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NPI Number | 1215238746
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Entity Type | Individual
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Provider Name | PAMELA KAREN TERRY POTEETE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 11673 DIAMOND LN
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City | WASHINGTON
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State | MI
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Zip | 48094-3126
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Country | US
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Telephone | 586-255-5074
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Fax |
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Provider Business Mailing Address
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Address Line | 11673 DIAMOND LN
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City | WASHINGTON
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State | MI
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Zip | 48094-3126
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Country | US
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Telephone | 586-255-5074
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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 | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number | 5201003725
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License Number State | MI
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