Provider Demographics
NPI:1992135537
Name:WHITE, NATALIE ANN
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
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 1:2121 ALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40210-2115
Mailing Address - Country:US
Mailing Address - Phone:502-741-4588
Mailing Address - Fax:
Practice Address - Street 1:2121 ALLSTON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-2115
Practice Address - Country:US
Practice Address - Phone:502-741-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004870A225X00000X
KYR4292225XE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
Provider Identifiers
StateIdentifier IDID TypeIssuer
31004870AOtherIN STATE OT BOARD
KYR4292OtherKY OT BOARD