Provider Demographics
NPI:1649475393
Name:POTTS, KAREN SUE (LPTA, RN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:POTTS
Suffix:
Gender:F
Credentials:LPTA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E FRIEND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-1477
Mailing Address - Country:US
Mailing Address - Phone:330-482-5393
Mailing Address - Fax:
Practice Address - Street 1:2473 NORTH RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3054
Practice Address - Country:US
Practice Address - Phone:330-372-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR.N. 189014163W00000X
OHPTA.02220225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant