Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OT 006577 | OH |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 006825 | GA |
NPI | 1891066544 |
---|---|
Provider Name | Dena Renee White |
First Address | Union City, GA 30291-6044 |
Second Address | Union City, GA 30291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2012 |
Last Update Date | 11/06/2019 |