Individual
LISA R WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1425 SHERIDAN AVE, NILES, MI 49120-1949
(269) 240-4759
Mailing address
1425 SHERIDAN AVE, NILES, MI 49120-1949
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001425
IN
Other
Enumeration date
01/27/2020
Last updated
01/27/2020
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