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General NPI Number Information
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NPI Number | 1306190517
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Entity Type | Individual
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Provider Name | MISS MORGAN A POTTS
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Gender | Female
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 389 PALM COAST PKWY SW UNIT 1
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City | PALM COAST
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State | FL
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Zip | 32137-4772
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Country | US
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Telephone | 386-597-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 2336 MEADOW LN
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City | PORT ORANGE
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State | FL
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Zip | 32128-3701
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | PTA 23351
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License Number State | FL
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