Provider Demographics
NPI:1295846871
Name:SLATER-WHITE, STACI L (OTR L)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:L
Last Name:SLATER-WHITE
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MS
Other - First Name:STACI
Other - Middle Name:L
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6404 NORTH 70TH PLAZA
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:402-573-3700
Mailing Address - Fax:402-573-3790
Practice Address - Street 1:2102 HARVELL CIRCLE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005
Practice Address - Country:US
Practice Address - Phone:402-293-5500
Practice Address - Fax:402-293-5505
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1008225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE276669Medicare ID - Type Unspecified
P90510Medicare UPIN