MEDICARE: MRS. VICTORIA ANN WHITE OT

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	15061	MA

General Provider Information

NPI Number	:	1235903360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA ANN WHITE OT

Provider Business Mailing Address
First Line	:	121 TOPSFIELD RD
Second Line	:
City	:	WENHAM
State	:	MA
Zip	:	01984-1933
Country	:	US
Telephone Number	:	203-214-9139
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 MERRIMACK ST STE 120
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1789
Country	:	US
Telephone Number	:	203-214-9139
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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