Provider Demographics
NPI:1801632609
Name:PETERS-WHITE, CHAVAE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CHAVAE
Middle Name:
Last Name:PETERS-WHITE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:DR
Other - First Name:CHAVAE
Other - Middle Name:
Other - Last Name:PETERS-WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:53 W CRYSTAL BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1947
Mailing Address - Country:US
Mailing Address - Phone:413-209-1138
Mailing Address - Fax:
Practice Address - Street 1:53 W CRYSTAL BROOK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1947
Practice Address - Country:US
Practice Address - Phone:413-209-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13855225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist