Provider Demographics
NPI:1982242202
Name:WHITE, ANDREW JASON (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JASON
Last Name:WHITE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:JASON
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:650 COLLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5464
Mailing Address - Country:US
Mailing Address - Phone:434-444-4386
Mailing Address - Fax:
Practice Address - Street 1:1229 COUNTRY FARM RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523
Practice Address - Country:US
Practice Address - Phone:540-586-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist