MEDICARE: BETH L 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	225XP0200X	Pediatric Occupational Therapist	18608	FL

General Provider Information

NPI Number	:	1619164845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH L WHITE OT

Provider Business Mailing Address
First Line	:	400 S ORLANDO AVE STE 204
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-5644
Country	:	US
Telephone Number	:	912-659-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S ORLANDO AVE STE 204
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-5644
Country	:	US
Telephone Number	:	912-659-9757
Fax Number	:

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

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	06/05/2024

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