Provider Demographics
NPI:1346569266
Name:POTOCKI, VIOLET (OTR/L, CDRS)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:
Last Name:POTOCKI
Suffix:
Gender:F
Credentials:OTR/L, CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CENTRAL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1777
Mailing Address - Country:US
Mailing Address - Phone:847-570-2060
Mailing Address - Fax:
Practice Address - Street 1:1000 CENTRAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1777
Practice Address - Country:US
Practice Address - Phone:847-570-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006669225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility