Individual
LACEY POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15881 COUNTY ROAD 3590, ADA, OK 74820-0483
(580) 235-3138
Mailing address
PO BOX 715, ADA, OK 74821-0715
(580) 235-3138
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/30/2017
Last updated
06/30/2017
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