Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225X00000X | Occupational Therapist | 304388 | LA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1346764495 |
---|---|
Provider Name | Dana Evans |
First Address | West Monroe, LA 71291-8740 |
Second Address | West Monroe, LA 71291-8740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2017 |
Last Update Date | 31/07/2017 |