Provider Demographics
NPI:1740586809
Name:WHITE, AMANDA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MICHELLE
Other - Last Name:CHRISTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5647 WITTMER MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-8802
Mailing Address - Country:US
Mailing Address - Phone:513-254-5175
Mailing Address - Fax:513-672-0580
Practice Address - Street 1:5647 WITTMER MEADOWS DRIVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8802
Practice Address - Country:US
Practice Address - Phone:513-254-5175
Practice Address - Fax:513-672-0580
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH74580222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist