Provider Demographics
NPI:1831223098
Name:WHITESELL, JOAN (OTR)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:WHITESELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ELIZABETH CT
Mailing Address - Street 2:
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-6100
Mailing Address - Country:US
Mailing Address - Phone:845-233-4213
Mailing Address - Fax:
Practice Address - Street 1:12 ELIZABETH CT
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580-6100
Practice Address - Country:US
Practice Address - Phone:845-233-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003580225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist