Provider Demographics
NPI:1902122807
Name:WHITE, COLLEEN FRANCES (OTR)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:FRANCES
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 PINE RUN RD
Mailing Address - Street 2:
Mailing Address - City:LEWIS RUN
Mailing Address - State:PA
Mailing Address - Zip Code:16738-1901
Mailing Address - Country:US
Mailing Address - Phone:814-362-1206
Mailing Address - Fax:
Practice Address - Street 1:381 PINE RUN RD
Practice Address - Street 2:
Practice Address - City:LEWIS RUN
Practice Address - State:PA
Practice Address - Zip Code:16738-1901
Practice Address - Country:US
Practice Address - Phone:814-362-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001622L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist