Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 0131000499 | VA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0119006215 | VA |
NPI | 1316215023 |
---|---|
Provider Name | Mrs. Stephanie Rose White |
First Address | Henrico, VA 23229 |
Second Address | Richmond, VA 23233-2028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2011 |
Last Update Date | 12/03/2014 |