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General NPI Number Information
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NPI Number | 1699982447
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Entity Type | Individual
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Provider Name | BRIAN WILLIAM POTTER ATC, EMT, OTC
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 1502 HARRISON AVE
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City | ELKINS
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State | WV
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Zip | 26241-3497
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Country | US
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Telephone | 304-637-4509
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Fax |
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Provider Business Mailing Address
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Address Line | 19 WOODY DR
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City | BUCKHANNON
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State | WV
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Zip | 26201-2437
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Country | US
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Telephone | 304-671-6780
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT001028
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License Number State | WV
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