Healthcare Provider Details

I. General information

NPI: 1104898030
Provider Name (Legal Business Name): MARGO ELIZABETH WHITE MOT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 NW 27TH ST
SUNRISE FL
33313-2139
US

IV. Provider business mailing address

6720 NW 27TH ST
SUNRISE FL
33313-2139
US

V. Phone/Fax

Practice location:
  • Phone: 954-747-3790
  • Fax: 954-572-8032
Mailing address:
  • Phone: 954-747-3790
  • Fax: 954-572-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT10482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: