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NPI Code Detail

MEDICARE: CHRISTOPHER JOHN POTTER ATC

MEDICARE: CHRISTOPHER JOHN POTTER ATC
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
12255A2300XAthletic Trainer002339OH

General Provider Information

NPI Number : 1780896761
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER JOHN POTTER ATC
Provider Business Mailing Address
First Line : 2226 CLEARVIEW AVE NW APT 3
Second Line :
City : CANTON
State : OH
Zip : 44708-2563
Country : US
Telephone Number : 330-705-8800
Fax Number :
Provider Business Practice Location Address
First Line : 6100 WHIPPLE AVE NW
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-7618
Country : US
Telephone Number : 330-244-8113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2007
Last Update Date : 07/08/2007

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Directions to “ CHRISTOPHER JOHN POTTER ATC” Practice Location

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