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General NPI Number Information
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NPI Number | 1154948552
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Entity Type | Individual
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Provider Name | MITCHELL WHITE OTR
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Gender | Male
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 9070 HARMONY DR STE A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73130-6257
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Country | US
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Telephone | 405-455-5582
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Fax |
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Provider Business Mailing Address
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Address Line | 8728 SW 36TH TER
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City | OKLAHOMA CITY
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State | OK
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Zip | 73179-3846
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Country | US
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Telephone | 580-551-9139
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5459
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License Number State | OK
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