Healthcare Provider Details

I. General information

NPI: 1093082802
Provider Name (Legal Business Name): EVELYN JANE ADIKES OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 BEACH TRL B
INDIAN ROCKS BEACH FL
33785-2949
US

IV. Provider business mailing address

2004 BEACH TRL B
INDIAN ROCKS BEACH FL
33785-2949
US

V. Phone/Fax

Practice location:
  • Phone: 914-497-3553
  • Fax: 855-497-3553
Mailing address:
  • Phone: 914-497-3553
  • Fax: 855-497-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: