Individual
TIFFANY POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4710 CHAMPIONS TRACE LN, STE. 104, LOUISVILLE, KY 40218-3495
(502) 589-8600
(502) 589-8771
Mailing address
2 SCHOOL ST, PLYMOUTH, MA 02360-3964
(508) 830-1234
(508) 830-1191
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518996354
NPI#
MA
Enumeration date
06/07/2007
Last updated
10/30/2020
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