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General NPI Number Information
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NPI Number | 1346870102
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Entity Type | Individual
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Provider Name | COURTNEY C WAITE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 1500 N JAMES ST
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City | ROME
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State | NY
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Zip | 13440-2844
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Country | US
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Telephone | 315-338-7154
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Fax |
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Provider Business Mailing Address
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Address Line | 245 MAIN ST APT A5
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City | NEW YORK MILLS
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State | NY
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Zip | 13417-1261
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Country | US
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Telephone |
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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 | 023158-1
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License Number State | NY
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