Individual
DEREK POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8350 CRAIG ST, INDIANAPOLIS, IN 46250-3593
(317) 578-0410
Mailing address
2323 COYNER AVE, INDIANAPOLIS, IN 46218-4331
(973) 641-2634
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-152377
IN
Other
Enumeration date
02/14/2021
Last updated
02/14/2021
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