Provider Demographics
NPI:1447463252
Name:POTTS, SHARON MICHELLE (COTA)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MICHELLE
Last Name:POTTS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6917 FIELDSTONE FARMS
Mailing Address - Street 2:
Mailing Address - City:OFALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8097
Mailing Address - Country:US
Mailing Address - Phone:636-300-3055
Mailing Address - Fax:636-300-3055
Practice Address - Street 1:11701 BORMAN DRIVE
Practice Address - Street 2:SUITE 280
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:866-433-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005344224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant