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General NPI Number Information
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NPI Number | 1114092426
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Entity Type | Organization
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Legal Business Name | KAREN S. WHITE
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 3193 HOLLY MILL RUN
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City | MARIETTA
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State | GA
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Zip | 30062-5480
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Country | US
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Telephone | 770-653-3077
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Fax | 770-509-1321
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Provider Business Mailing Address
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Address Line | 3193 HOLLY MILL RUN
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City | MARIETTA
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State | GA
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Zip | 30062-5480
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Country | US
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Telephone | 770-653-3077
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Fax | 770-509-1321
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Authorized Official
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Title or Position | OWNER
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Name | KAREN WHITE
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Credential | OTR L
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Telephone | 770-653-3077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 003993
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License Number State | GA
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