Individual
MIRIAM KRISITIYAHNA WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
19250 SW 65TH AVE STE 125, TUALATIN, OR 97062-7745
(503) 692-1670
(503) 692-1669
Mailing address
PO BOX 6689, PORTLAND, OR 97228-6689
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
278883
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/16/2009
Last updated
03/10/2015
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