MEDICARE: ERIC O POTTER SR. ATP, COTA

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	224Z00000X	Occupational Therapy Assistant	210657	TX
2	247200000X	Other Technician	98550	TX

General Provider Information

NPI Number	:	1497038103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC O POTTER SR. ATP, COTA

Provider Business Mailing Address
First Line	:	9350 KIRBY DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2528
Country	:	US
Telephone Number	:	860-212-6825
Fax Number	:	877-799-1904

Provider Business Practice Location Address
First Line	:	9350 KIRBY DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2528
Country	:	US
Telephone Number	:	860-212-6825
Fax Number	:	877-799-1904

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	07/12/2024

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