MEDICARE: MS. AUDREY MARYANNE WHITE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	0062	NV
2	225X00000X	Occupational Therapist	0062	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0062	OTHER	NV	LICENSE#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386754893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AUDREY MARYANNE WHITE OTR/L

Provider Business Mailing Address
First Line	:	10785 W TWAIN AVE STE 250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3026
Country	:	US
Telephone Number	:	725-726-7847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 W CHARLESTON BLVD STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1942
Country	:	US
Telephone Number	:	725-726-7847
Fax Number	:	725-726-7876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/29/2022

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Directions to “ MS. AUDREY MARYANNE WHITE OTR/L” Practice Location

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