Provider Demographics
NPI:1891572475
Name:POTTER, GABRIEL (HAS)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:POTTER
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 W 2ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-3770
Mailing Address - Country:US
Mailing Address - Phone:937-708-8824
Mailing Address - Fax:
Practice Address - Street 1:492 W 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3770
Practice Address - Country:US
Practice Address - Phone:937-708-8824
Practice Address - Fax:937-889-2952
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03483237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter