Provider Demographics
NPI:1548483936
Name:POTTER, LISA ANN (DEVELOPMENTAL INTERV)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:POTTER
Suffix:
Gender:F
Credentials:DEVELOPMENTAL INTERV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 POPPY DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-7955
Mailing Address - Country:US
Mailing Address - Phone:606-836-0606
Mailing Address - Fax:606-836-0606
Practice Address - Street 1:70 POPPY DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-7955
Practice Address - Country:US
Practice Address - Phone:606-836-0606
Practice Address - Fax:606-836-0606
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1712222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist