Individual
LIDU IVETTE POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
971 VIRGINIA AVE, SUITE A, PALM HARBOR, FL 34683-5235
(727) 773-2687
(727) 773-2742
Mailing address
2150 ALT 19 STE A, PALM, FL 34683-5363
(727) 773-2687
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT10194
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
887471900
—
FL
Enumeration date
08/23/2006
Last updated
08/09/2017
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