Provider Demographics
NPI:1740697390
Name:WHITE, SUSAN (OT/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 GALLOP LN
Mailing Address - Street 2:
Mailing Address - City:BAHAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27503-9633
Mailing Address - Country:US
Mailing Address - Phone:919-475-5648
Mailing Address - Fax:
Practice Address - Street 1:9601 GALLOP LN
Practice Address - Street 2:
Practice Address - City:BAHAMA
Practice Address - State:NC
Practice Address - Zip Code:27503-9633
Practice Address - Country:US
Practice Address - Phone:919-475-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2542225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation