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General NPI Number Information
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NPI Number | 1790242485
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Entity Type | Individual
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Provider Name | JESSICA WHITE ATC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 293 BENEDICT AVE
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City | TARRYTOWN
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State | NY
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Zip | 10591-4327
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Country | US
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Telephone | 914-366-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 106 BON AIRE CIR W APT 8N
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City | SUFFERN
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State | NY
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Zip | 10901-7041
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 003613
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License Number State | NY
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