Healthcare Provider Details

I. General information

NPI: 1023723897
Provider Name (Legal Business Name): MELISSA EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 LYNDELL TER STE 200
DAVIS CA
95616-6222
US

IV. Provider business mailing address

1301 E BIDWELL ST STE 201
FOLSOM CA
95630-3565
US

V. Phone/Fax

Practice location:
  • Phone: 800-382-5011
  • Fax:
Mailing address:
  • Phone: 916-983-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number24282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: