MEDICARE: MITCHELL WHITE OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5459	OK

General Provider Information

NPI Number	:	1154948552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL WHITE OTR

Provider Business Mailing Address
First Line	:	8728 SW 36TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-3846
Country	:	US
Telephone Number	:	580-551-9139
Fax Number	:

Provider Business Practice Location Address
First Line	:	9070 HARMONY DR STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73130-6257
Country	:	US
Telephone Number	:	405-455-5582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	07/01/2020

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Directions to “ MITCHELL WHITE OTR” Practice Location

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