Provider Demographics
NPI:1184196974
Name:WHITE, DEADRE (OT/L)
Entity Type:Individual
Prefix:DR
First Name:DEADRE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 STRAUSBERG ST
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-2839
Mailing Address - Country:US
Mailing Address - Phone:301-518-4570
Mailing Address - Fax:
Practice Address - Street 1:1400 NALLEY TER
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4434
Practice Address - Country:US
Practice Address - Phone:301-618-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03791225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics