Provider Demographics
NPI:1396980140
Name:WHITE, MONIQUE ALLISIANNE (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:ALLISIANNE
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 1:1815 E 48TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3718
Mailing Address - Country:US
Mailing Address - Phone:917-847-0486
Mailing Address - Fax:
Practice Address - Street 1:1815 E 48TH ST
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3718
Practice Address - Country:US
Practice Address - Phone:917-847-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012004225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics