Provider Demographics
NPI:1487774535
Name:WHITE, RYAN DANIEL (MS, OTR)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DANIEL
Last Name:WHITE
Suffix:
Gender:M
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007
Mailing Address - Country:US
Mailing Address - Phone:207-318-4326
Mailing Address - Fax:866-789-8027
Practice Address - Street 1:1950 CALLE BARCELONA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009
Practice Address - Country:US
Practice Address - Phone:866-422-7053
Practice Address - Fax:866-789-8027
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8993225X00000X
HI735225X00000X
MEOT2280225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist