Individual
EBONY WHITE PETERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L, CLT
Contact information
Practice address
241 MCLAWS CIR STE 105, WILLIAMSBURG, VA 23185-5861
(757) 503-9665
Mailing address
10512 TEA OLIVE CIR, PROVIDENCE FORGE, VA 23140-4528
(804) 687-3140
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
0119004514
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119004514
VIRGINIA LICENSE
VA
Enumeration date
11/21/2022
Last updated
11/21/2022
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