MEDICARE: ANTTONIQUE 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	106S00000X	Behavior Technician		MI

General Provider Information

NPI Number	:	1821937087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTTONIQUE POTTS

Provider Business Mailing Address
First Line	:	15355 BURT RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1640
Country	:	US
Telephone Number	:	313-736-8454
Fax Number	:

Provider Business Practice Location Address
First Line	:	20700 CIVIC CENTER DR STE 100
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-4108
Country	:	US
Telephone Number	:	800-385-1035
Fax Number	:

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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Directions to “ ANTTONIQUE POTTS ” Practice Location

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