Provider Demographics
NPI:1720254519
Name:WHITE, CYNTHIA YVETTE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:YVETTE
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 1:5612 RIVERMILL CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1570
Mailing Address - Country:US
Mailing Address - Phone:757-319-5044
Mailing Address - Fax:
Practice Address - Street 1:5612 RIVERMILL CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-1570
Practice Address - Country:US
Practice Address - Phone:757-319-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119003551OtherVA BOARD OF MEDICINE