Healthcare Provider Details

I. General information

NPI: 1255487948
Provider Name (Legal Business Name): LYNNE ANNE WHITE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MADISON
JEFFERSON MO
65102-1128
US

IV. Provider business mailing address

3525 GETTYSBURG PL
JEFFERSON CITY MO
65109-6831
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-5628
  • Fax:
Mailing address:
  • Phone: 573-893-5281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number001013
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: