Healthcare Provider Details

I. General information

NPI: 1962464941
Provider Name (Legal Business Name): KIMBERLY WHITE LEROY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ELAINE WHITE OTR/L

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 FORT SANDERS WEST BLVD STE 110
KNOXVILLE TN
37922-3355
US

IV. Provider business mailing address

260 FORT SANDERS WEST BLVD STE 110
KNOXVILLE TN
37922-3355
US

V. Phone/Fax

Practice location:
  • Phone: 865-558-4491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5337
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT12357
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4393
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: