Provider Demographics
NPI:1821496225
Name:POTVIN, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:POTVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:POTVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT
Mailing Address - Street 1:6066 S SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4585
Mailing Address - Country:US
Mailing Address - Phone:720-351-3559
Mailing Address - Fax:
Practice Address - Street 1:6066 S SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-4585
Practice Address - Country:US
Practice Address - Phone:720-351-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8034OtherLICENSE