Provider Demographics
NPI:1174263412
Name:WHITE, GINNY CHRISTINE (COTA)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:CHRISTINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CARLYLE CLOSE APT 1008
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1830
Mailing Address - Country:US
Mailing Address - Phone:423-534-5419
Mailing Address - Fax:
Practice Address - Street 1:650 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7864
Practice Address - Country:US
Practice Address - Phone:251-220-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5757224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant