Provider Demographics
NPI:1477896033
Name:POTTEIGER, KELLY IRENE (MED)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:IRENE
Last Name:POTTEIGER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3166
Mailing Address - Country:US
Mailing Address - Phone:717-608-7036
Mailing Address - Fax:717-790-0272
Practice Address - Street 1:59 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3166
Practice Address - Country:US
Practice Address - Phone:717-608-7036
Practice Address - Fax:717-790-0272
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator