MEDICARE: ASHLEE POTTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2142	OK

General Provider Information

NPI Number	:	1053883967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE POTTER

Provider Business Mailing Address
First Line	:	13167 E 131ST ST N
Second Line	:
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-4377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2257 W WASHINGTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6703
Country	:	US
Telephone Number	:	918-994-7799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	12/18/2018

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Directions to “ ASHLEE POTTER ” Practice Location

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