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NPI Code Detail

MEDICARE: MELLISA L WHITE OTR/L

MEDICARE: MELLISA L WHITE OTR/L
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
1225XP0200XPediatric Occupational Therapist538SC

General Provider Information

NPI Number : 1649695883
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELLISA L WHITE OTR/L
Provider Business Mailing Address
First Line : 100 TARRAR SPRINGS RD
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-3835
Country : US
Telephone Number : 803-821-1101
Fax Number :
Provider Business Practice Location Address
First Line : 100 TARRAR SPRINGS RD
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-3835
Country : US
Telephone Number : 803-821-1101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2014
Last Update Date : 11/11/2020

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Directions to “ MELLISA L WHITE OTR/L” Practice Location

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