Provider Demographics
NPI:1952304875
Name:POTTER, CAROL GRAY (OTR/L, BCG)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:GRAY
Last Name:POTTER
Suffix:
Gender:F
Credentials:OTR/L, BCG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CANDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1914
Mailing Address - Country:US
Mailing Address - Phone:425-478-6098
Mailing Address - Fax:425-977-7193
Practice Address - Street 1:21 CANDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-1914
Practice Address - Country:US
Practice Address - Phone:425-478-6098
Practice Address - Fax:425-977-7193
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6281225XG0600X
WA1963225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0153392OtherLABOR & INDUSTRIES
WA7682305Medicaid
WA0373POOtherREGENCE BS
WAP28598Medicare UPIN
WA7682305Medicaid