Provider Demographics
NPI:1386094456
Name:WHITE, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RAPP RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4491
Mailing Address - Country:US
Mailing Address - Phone:518-867-3061
Mailing Address - Fax:
Practice Address - Street 1:1 OXFORD DR
Practice Address - Street 2:APT 6
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2023
Practice Address - Country:US
Practice Address - Phone:518-512-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant