Healthcare Provider Details

I. General information

NPI: 1467197400
Provider Name (Legal Business Name): ALLISON EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 SEA LARK LN
NAVARRE FL
32566-7406
US

IV. Provider business mailing address

101 E ROMANA ST APT 459
PENSACOLA FL
32502-5866
US

V. Phone/Fax

Practice location:
  • Phone: 850-204-8030
  • Fax:
Mailing address:
  • Phone: 731-445-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: