Provider Demographics
NPI:1386754893
Name:WHITE, AUDREY MARYANNE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:MARYANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:MARYANNE
Other - Last Name:LLOYD-DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:10785 W TWAIN AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3026
Mailing Address - Country:US
Mailing Address - Phone:725-726-7847
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:725-726-7847
Practice Address - Fax:725-726-7876
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0062225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0062OtherLICENSE#
NV1386754893Medicaid