Individual
SUMMER POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
101 MONROE ST, PETALUMA, CA 94954-2328
(707) 763-4109
Mailing address
336 PAYRAN ST, PETALUMA, CA 94952-3208
(480) 406-1490
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4539
CA
224Z00000X
Occupational Therapy Assistant
6984
AZ
Other
Enumeration date
04/24/2017
Last updated
05/15/2021
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