Individual
WILMA BEVERLY WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3405
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2375568
ALLIED HEALTH PROFESSIONAL LIABILITY
NM
Enumeration date
06/15/2017
Last updated
07/21/2022
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