Provider Demographics
NPI:1497038103
Name:POTTER, ERIC O SR (ATP, COTA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:O
Last Name:POTTER
Suffix:SR
Gender:M
Credentials:ATP, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 KIRBY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2528
Mailing Address - Country:US
Mailing Address - Phone:860-212-6825
Mailing Address - Fax:877-799-1904
Practice Address - Street 1:9350 KIRBY DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2528
Practice Address - Country:US
Practice Address - Phone:860-212-6825
Practice Address - Fax:877-799-1904
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210657224Z00000X
TX98550247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant