| Doctor Name: | MIRIAM KRISITIYAHNA WHITE |
| NPI Number: | 1639402027 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OTD, OTR/L |
| License Number: | |
| Business Practice Address: | 19250 Sw 65th Ave Ste 125 Tualatin, OR - 970627745 |
| Business Phone Number: | 5036921670 |
| Business Fax Number: | 5036921669 |
| Mailing Address: | Po Box 6689, PORTLAND |
| State: | OR |
| Postal Code: | 972286689 |
| Phone Number: | 5034133900 |
| Fax Number: | 5034133710 |
| NPI Enumeration Date: | 09/16/2009 |
| NPI Last Update Date: | 03/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |