Healthcare Provider Details

I. General information

NPI: 1104072164
Provider Name (Legal Business Name): MELINDA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 6TH ST
ERIE PA
16501-1201
US

IV. Provider business mailing address

101 E 6TH ST P.O. BOX 1506
ERIE PA
16501-1201
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-2755
  • Fax: 814-456-4873
Mailing address:
  • Phone: 814-459-2755
  • Fax: 814-456-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number008777-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: