Provider Demographics
NPI:1720329899
Name:WHITE, TONI MASTRODONATO (OT, MOTR)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:MASTRODONATO
Last Name:WHITE
Suffix:
Gender:F
Credentials:OT, MOTR
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:ANN
Other - Last Name:MASTRODONATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:174 W 138TH ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-4131
Mailing Address - Country:US
Mailing Address - Phone:985-691-1234
Mailing Address - Fax:
Practice Address - Street 1:104 WEST 134TH PLACE
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345
Practice Address - Country:US
Practice Address - Phone:985-632-7919
Practice Address - Fax:985-632-3581
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTA 200359224Z00000X
LA311473225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant