MEDICARE: MISS MORGAN A POTTS

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	235Z00000X	Speech-Language Pathologist	PTA 23351	FL

General Provider Information

NPI Number	:	1306190517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MORGAN A POTTS

Provider Business Mailing Address
First Line	:	2336 MEADOW LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-3701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	389 PALM COAST PKWY SW UNIT 1
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4772
Country	:	US
Telephone Number	:	386-597-2820
Fax Number	:

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

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	11/09/2012

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Directions to “ MISS MORGAN A POTTS ” Practice Location

Language	Start Address	Practice Location

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