Provider Demographics
NPI:1548574627
Name:WHITE, SUE ANN (OT/L)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:RABOUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MA
Mailing Address - Zip Code:01254-0138
Mailing Address - Country:US
Mailing Address - Phone:413-652-3344
Mailing Address - Fax:
Practice Address - Street 1:106 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MA
Practice Address - Zip Code:01237
Practice Address - Country:US
Practice Address - Phone:413-652-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000792-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist