Provider Demographics
NPI:1174364046
Name:POTOCNIK, WILLIAM (OTR/L)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:POTOCNIK
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:POTOCNIK
Other - Last Name:JUENEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:270 N BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-9186
Mailing Address - Country:US
Mailing Address - Phone:487-287-8472
Mailing Address - Fax:
Practice Address - Street 1:799 W BOYLSTON ST STE 7
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-3071
Practice Address - Country:US
Practice Address - Phone:617-738-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL15380225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist