Individual
MRS. MARY ANN WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12147 FORESTVILLE RD, SILVER CREEK, NY 14136-1608
(716) 934-2516
Mailing address
12147 FORESTVILLE RD, SILVER CREEK, NY 14136-1608
(716) 934-2516
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
006231-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006231 - 1
LICENSE/CERTIFICATE
NY
Enumeration date
06/04/2008
Last updated
06/04/2008
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