Provider Demographics
NPI:1255487948
Name:WHITE, LYNNE ANNE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:ANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 GETTYSBURG PL
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6831
Mailing Address - Country:US
Mailing Address - Phone:573-893-5281
Mailing Address - Fax:
Practice Address - Street 1:1125 MADISON
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:MO
Practice Address - Zip Code:65102-1128
Practice Address - Country:US
Practice Address - Phone:573-632-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001013225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation