Provider Demographics
NPI:1487240412
Name:WHITE, RILEY ANDREAS (COTA/L)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:ANDREAS
Last Name:WHITE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30334 RIVER RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVER RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:33867-1213
Mailing Address - Country:US
Mailing Address - Phone:864-804-7296
Mailing Address - Fax:
Practice Address - Street 1:725 S PINE ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3654
Practice Address - Country:US
Practice Address - Phone:863-385-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant