Provider Demographics
NPI:1376715821
Name:POTTBERG, LINDA LEE MAYBEN (MOT, MOTR/L)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE MAYBEN
Last Name:POTTBERG
Suffix:
Gender:F
Credentials:MOT, MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 SW 34TH ST APT 901
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8403
Mailing Address - Country:US
Mailing Address - Phone:352-275-7746
Mailing Address - Fax:
Practice Address - Street 1:3021 SW 27TH AVE # 2
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0105
Practice Address - Country:US
Practice Address - Phone:352-275-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist