Provider Demographics
NPI:1770833519
Name:WHITE, BARBARA R (MS, OTL)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:PO BOX 552
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-3002
Mailing Address - Country:US
Mailing Address - Phone:207-578-0503
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-3002
Practice Address - Country:US
Practice Address - Phone:207-578-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant