MEDICARE: MAISON BRIELLE WHITE

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	225X00000X	Occupational Therapist	OT25837	CA

General Provider Information

NPI Number	:	1740059120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAISON BRIELLE WHITE

Provider Business Mailing Address
First Line	:	6216 W ORIOLE CT
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-8118
Country	:	US
Telephone Number	:	559-741-5725
Fax Number	:

Provider Business Practice Location Address
First Line	:	6216 W ORIOLE CT
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-8118
Country	:	US
Telephone Number	:	559-741-5725
Fax Number	:

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

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	04/27/2026

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Directions to “ MAISON BRIELLE WHITE ” Practice Location

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