Provider Demographics
NPI:1679052294
Name:WHYTE, RUTH HEATHER (OTR/L)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:HEATHER
Last Name:WHYTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 PINEY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2335
Mailing Address - Country:US
Mailing Address - Phone:336-996-5866
Mailing Address - Fax:
Practice Address - Street 1:728 PINEY GROVE RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2335
Practice Address - Country:US
Practice Address - Phone:336-996-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist