Provider Demographics
NPI:1750620514
Name:WHITE, NIKEL (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NIKEL
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1213
Mailing Address - Country:US
Mailing Address - Phone:347-436-3667
Mailing Address - Fax:
Practice Address - Street 1:135 CEDAR CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1213
Practice Address - Country:US
Practice Address - Phone:347-436-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005520225X00000X
NY017473225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist