Provider Demographics
NPI:1861930034
Name:POTTER, ELIZABETH (COTA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672075
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-2075
Mailing Address - Country:US
Mailing Address - Phone:907-726-4663
Mailing Address - Fax:844-605-1820
Practice Address - Street 1:22502 SAMBAR LOOP
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5377
Practice Address - Country:US
Practice Address - Phone:907-726-4663
Practice Address - Fax:844-605-1820
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102711224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant