Provider Demographics
NPI:1790377802
Name:POTTER, PRESTON ALAYNE (OTR/L)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:ALAYNE
Last Name:POTTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:PRESTON
Other - Middle Name:ALAYNE
Other - Last Name:RIEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8832 NE 101ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-7887
Mailing Address - Country:US
Mailing Address - Phone:308-529-8176
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03749225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist