Provider Demographics
NPI:1790526309
Name:WHITE, DENISE GRACE (COTA/L)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:GRACE
Last Name:WHITE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-4648
Mailing Address - Country:US
Mailing Address - Phone:434-728-0094
Mailing Address - Fax:
Practice Address - Street 1:2344 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4212
Practice Address - Country:US
Practice Address - Phone:434-791-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000699224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant