Provider Demographics
NPI:1114092426
Name:KAREN S. WHITE
Entity Type:Organization
Organization Name:KAREN S. WHITE
Other - Org Name:DYNAMIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR L
Authorized Official - Phone:770-653-3077
Mailing Address - Street 1:3193 HOLLY MILL RUN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5480
Mailing Address - Country:US
Mailing Address - Phone:770-653-3077
Mailing Address - Fax:770-509-1321
Practice Address - Street 1:3193 HOLLY MILL RUN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5480
Practice Address - Country:US
Practice Address - Phone:770-653-3077
Practice Address - Fax:770-509-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003993225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA506446488AMedicaid