Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 110533 | TX |
NPI | 1053891846 |
---|---|
Provider Name | Sharyl Ann Evans |
First Address | Pottsboro, TX 75076 |
Second Address | Sherman, TX 75090-3112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |