Provider Demographics
NPI:1073870408
Name:POTTER, LUCILLE E (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:E
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 554
Mailing Address - Street 2:284 MAIN RD.
Mailing Address - City:CORINTH
Mailing Address - State:ME
Mailing Address - Zip Code:04427
Mailing Address - Country:US
Mailing Address - Phone:207-285-0020
Mailing Address - Fax:207-884-8155
Practice Address - Street 1:284 MAIN RD.
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:ME
Practice Address - Zip Code:04427
Practice Address - Country:US
Practice Address - Phone:207-285-0020
Practice Address - Fax:207-884-8155
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist