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Individual
MRS. MISTY LEIGH WHITE- KING
Active
Individual
MRS. MISTY LEIGH WHITE- KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OCCUPATIONAL THERAPY
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056005570
IL
332B00000X
Durable Medical Equipment & Medical Supplies
056005570
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8432032
BCBS PROVIDER NUMBER
IL
Enumeration date
11/07/2006
Last updated
07/24/2015
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