Healthcare Provider Details

I. General information

NPI: 1992135537
Provider Name (Legal Business Name): NATALIE ANN WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ALLSTON AVE
LOUISVILLE KY
40210-2115
US

IV. Provider business mailing address

2121 ALLSTON AVE
LOUISVILLE KY
40210-2115
US

V. Phone/Fax

Practice location:
  • Phone: 502-741-4588
  • Fax:
Mailing address:
  • Phone: 502-741-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31004870A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberR4292
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: