Provider Demographics
NPI:1689857773
Name:WHITE, RYAN G (MOT, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:G
Last Name:WHITE
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4517
Mailing Address - Country:US
Mailing Address - Phone:732-897-0820
Mailing Address - Fax:
Practice Address - Street 1:1303 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4517
Practice Address - Country:US
Practice Address - Phone:732-897-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ#46TR00128600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist