Kristi A White, OTR/L
Individual provider Active NPI Occupational Therapist · Havana, IL
NPI 1306180203 · NPPES record last updated Nov 15, 2012
Key facts
- NPI
- 1306180203
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 056009677 (IL)
- Practice address
- 615 N Promenade St
Havana, IL 62644-1243 - Phone
- (309) 543-8578
- NPI assigned
- Nov 15, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056009677 | IL | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056009677 | IL | Yes |
Addresses
Primary practice location
615 N Promenade St
Havana, IL 62644-1243
Mailing address
615 N Promenade St
Havana, IL 62644-1243
Phone (309) 543-8578
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 376017857001 | Medicaid | IL |
Other providers in Havana, IL
- Kali Troxell
- Carlos Alberto Urdininea Kirkwood
- Jeremiah Vance
- Richard W Wagoner
- Makayla Renee Watson
- Morgan M Wiggs
- Willow Brook Counseling and Wellness, PLLC
- Willow Ridge Hospice LLC
- Megan Wilson
- Tad A Yetter
All providers in Havana, IL · Occupational Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.