MEDICARE: KATIE LATRICE WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	311ZA0620X	Adult Care Home Facility	OH
2	347C00000X	Private Vehicle	OH
3	253Z00000X	In Home Supportive Care Agency	OH
4	3104A0625X	Assisted Living Facility (Mental Illness)	OH
5	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	OH
6	311Z00000X	Custodial Care Facility	OH
7	172A00000X	Driver	OH
8	251B00000X	Case Management Agency	OH
9	171400000X	Health & Wellness Coach	OH
10	251S00000X	Community/Behavioral Health Agency	OH
11	372600000X	Adult Companion	OH
12	3747A0650X	Attendant Care Provider	OH
13	3747P1801X	Personal Care Attendant	OH
14	374U00000X	Home Health Aide	OH
15	376K00000X	Nurse's Aide	OH

General Provider Information

NPI Number	:	1992483390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE LATRICE WHITE

Provider Business Mailing Address
First Line	:	609 TRENTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-2041
Country	:	US
Telephone Number	:	513-526-9279
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 TRENTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-2041
Country	:	US
Telephone Number	:	513-526-9279
Fax Number	:

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

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/06/2023

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Directions to “ KATIE LATRICE WHITE ” Practice Location

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