MEDICARE: JESSICA 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	OT15773	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265866545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WHITE OTR

Provider Business Mailing Address
First Line	:	6617 WOODS ISLAND CIR APT 108
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-1468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6617 WOODS ISLAND CIR APT 108
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-1468
Country	:	US
Telephone Number	:	772-464-3303
Fax Number	:

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

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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