Healthcare Provider Details

I. General information

NPI: 1801800040
Provider Name (Legal Business Name): JAYNE ANN WHITE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3204
US

IV. Provider business mailing address

228 W COUNTRY WALK DR
ROUND LAKE BEACH IL
60073-4009
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-3344
  • Fax: 847-549-6920
Mailing address:
  • Phone: 847-356-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: