Provider Demographics
NPI:1477967537
Name:POTTER, JAMIE (IECE)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 FLINT RDG
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-7112
Mailing Address - Country:US
Mailing Address - Phone:859-638-2068
Mailing Address - Fax:
Practice Address - Street 1:812 FLINT RDG
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-7112
Practice Address - Country:US
Practice Address - Phone:859-638-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist