Provider Demographics
NPI:1215161641
Name:WHITE, DONNA MICHELLE
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MICHELLE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:17828 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3701
Mailing Address - Country:US
Mailing Address - Phone:954-885-0475
Mailing Address - Fax:
Practice Address - Street 1:17828 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3701
Practice Address - Country:US
Practice Address - Phone:954-885-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0T10137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist