Provider Demographics
NPI:1235501958
Name:WHITE, PRISCILLA FAYE (COTA)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:FAYE
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 1:2010 SW H K DODGEN LOOP
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7062
Mailing Address - Country:US
Mailing Address - Phone:254-774-9991
Mailing Address - Fax:
Practice Address - Street 1:2010 SW H K DODGEN LOOP
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7062
Practice Address - Country:US
Practice Address - Phone:254-774-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212758224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant