MEDICARE: MRS. LYNNE ANNE 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	225XN1300X	Neurorehabilitation Occupational Therapist	001013	MO

General Provider Information

NPI Number	:	1255487948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNNE ANNE WHITE OTR

Provider Business Mailing Address
First Line	:	3525 GETTYSBURG PL
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6831
Country	:	US
Telephone Number	:	573-893-5281
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 MADISON
Second Line	:
City	:	JEFFERSON
State	:	MO
Zip	:	65102-1128
Country	:	US
Telephone Number	:	573-632-5628
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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