Provider Demographics
NPI:1457758989
Name:WHITE, ANNA LILLIAN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:LILLIAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:LILLIAN
Other - Last Name:PHELIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9110 RUSTLERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4054
Mailing Address - Country:US
Mailing Address - Phone:210-367-8936
Mailing Address - Fax:
Practice Address - Street 1:765 ALLENS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-5443
Practice Address - Country:US
Practice Address - Phone:401-432-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114783225X00000X
MA11275225X00000X
RIOT00151-T225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist