Healthcare Provider Details

I. General information

NPI: 1891066544
Provider Name (Legal Business Name): DENA RENEE WHITE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 LAKEVIEW RD
UNION CITY GA
30291
US

IV. Provider business mailing address

9535 LAKEVIEW RD
UNION CITY GA
30291-6044
US

V. Phone/Fax

Practice location:
  • Phone: 216-789-8998
  • Fax:
Mailing address:
  • Phone: 216-789-8998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number006825
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT 006577
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: