Provider Demographics
NPI:1083232367
Name:POTTER, MELISSA LOUISE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LOUISE
Last Name:POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 BALDWICK RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-4104
Mailing Address - Country:US
Mailing Address - Phone:412-922-8322
Mailing Address - Fax:
Practice Address - Street 1:2510 BALDWICK RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4104
Practice Address - Country:US
Practice Address - Phone:412-922-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist