Provider Demographics
NPI:1619639267
Name:POTENTIAL CT LLC
Entity Type:Organization
Organization Name:POTENTIAL CT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASCARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:860-595-2334
Mailing Address - Street 1:3 RATHBUN RD APT 10
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1745
Mailing Address - Country:US
Mailing Address - Phone:860-595-2334
Mailing Address - Fax:
Practice Address - Street 1:3 RATHBUN RD APT 10
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1745
Practice Address - Country:US
Practice Address - Phone:860-595-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty