Provider Demographics
NPI:1518274661
Name:WHITE, AMY L C (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L C
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1002
Mailing Address - Country:US
Mailing Address - Phone:607-749-2230
Mailing Address - Fax:
Practice Address - Street 1:4 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1002
Practice Address - Country:US
Practice Address - Phone:607-749-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07900-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist