Provider Demographics
NPI:1922831387
Name:WHITE, X'AVIA AIGNYE (OTD)
Entity type:Individual
Prefix:
First Name:X'AVIA
Middle Name:AIGNYE
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SPICE TRADER WAY APT G
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7444
Mailing Address - Country:US
Mailing Address - Phone:407-350-6523
Mailing Address - Fax:
Practice Address - Street 1:830 29TH ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6219
Practice Address - Country:US
Practice Address - Phone:407-843-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist