Individual
MR. EDWARD ANDREW POTEREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
4646 JOHN R ST, OCCUPATIONAL THERAPY DEPARTMENT, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
4646 JOHN R ST, OCCUPATIONAL THERAPY DEPARTMENT, DETROIT, MI 48201-1916
(313) 576-1000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201001507
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5201001507
MICHIGAN LICENSE
MI
Enumeration date
07/22/2011
Last updated
07/22/2011
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