Provider Demographics
NPI:1508978156
Name:POTTS, SHARRIE LEE (OTR)
Entity Type:Individual
Prefix:MS
First Name:SHARRIE
Middle Name:LEE
Last Name:POTTS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 LA RUE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5010
Mailing Address - Country:US
Mailing Address - Phone:210-831-6662
Mailing Address - Fax:
Practice Address - Street 1:5121 CRESTWAY DR
Practice Address - Street 2:STE 507
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-1980
Practice Address - Country:US
Practice Address - Phone:210-646-8008
Practice Address - Fax:210-646-8242
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107737225XN1300X
TX107737T225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75285003678239A005OtherTRICARE
TX86084TOtherBCBS