Provider Demographics
NPI:1790730489
Name:WHITE, KAVINDRA MASHON (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KAVINDRA
Middle Name:MASHON
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:KAVINDRA
Other - Middle Name:MASHON
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3400 LEBANON RD
Mailing Address - Street 2:PHYSICAL MEDICINE & REHABILITATION (117)
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-225-3762
Mailing Address - Fax:615-225-5351
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:PHYSICAL MEDICINE & REHABILITATION (117)
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-225-3762
Practice Address - Fax:615-225-5351
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist