Healthcare Provider Details

I. General information

NPI: 1902597933
Provider Name (Legal Business Name): REMI NICOLE WHITE MAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 S CREGIER AVE
CHICAGO IL
60617-2957
US

IV. Provider business mailing address

8833 S CREGIER AVE
CHICAGO IL
60617-2957
US

V. Phone/Fax

Practice location:
  • Phone: 773-573-7544
  • Fax:
Mailing address:
  • Phone: 773-573-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: