Provider Demographics
NPI:1245427079
Name:POTEAT, KIMBERLEY YVETTE (COTA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:YVETTE
Last Name:POTEAT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-8113
Mailing Address - Country:US
Mailing Address - Phone:910-620-1450
Mailing Address - Fax:
Practice Address - Street 1:214 WEST ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-8113
Practice Address - Country:US
Practice Address - Phone:910-620-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5528224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant