Basic Information
| Provider Information | |||||||||
| NPI: | 1649475393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POTTS | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | L.P.T.A., R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 E FRIEND ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIANA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444081477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304825393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2473 NORTH RD NE | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444833054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303722251 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R.N. 189014 | OH | X | Nursing Service Providers | Registered Nurse | 225200000X | PTA.02220 | OH | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.