Provider Demographics
NPI:1831440213
Name:POTOCEK, KATHRYN
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:POTOCEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HELLY HILL RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18845-7732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13609 CALIFORNIA ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5245
Practice Address - Country:US
Practice Address - Phone:180-045-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007187225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation