MEDICARE: TAYLOR NICOLE 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	21751	FL
2	225X00000X	Occupational Therapist	21571	FL

General Provider Information

NPI Number	:	1295329571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR NICOLE WHITE OTR

Provider Business Mailing Address
First Line	:	285 OLD VILLAGE CENTER CIR UNIT 5203
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32084-5817
Country	:	US
Telephone Number	:	843-503-4461
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 OLD VILLAGE CENTER CIR UNIT 5203
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32084-5817
Country	:	US
Telephone Number	:	843-503-4461
Fax Number	:

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

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	04/30/2024

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