Healthcare Provider Details

I. General information

NPI: 1013891290
Provider Name (Legal Business Name): MEGAN IVONNAVA CHUCUEN EVANS OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 MEDLEY CT
VINE GROVE KY
40175-8421
US

IV. Provider business mailing address

298 MEDLEY CT
VINE GROVE KY
40175-8421
US

V. Phone/Fax

Practice location:
  • Phone: 270-352-1133
  • Fax:
Mailing address:
  • Phone: 270-352-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number301305
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: