Provider Demographics
NPI:1902840036
Name:POTTER, ANNA IANNI (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:IANNI
Last Name:POTTER
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:N31W7281 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2264
Mailing Address - Country:US
Mailing Address - Phone:262-375-8907
Mailing Address - Fax:
Practice Address - Street 1:COLUMBIA HOSPITAL
Practice Address - Street 2:2025 E. NEWPORT AVENUE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-961-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2913-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist