Healthcare Provider Details

I. General information

NPI: 1417704701
Provider Name (Legal Business Name): CHERYL ANNE EVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 SW 6TH ST
REDMOND OR
97756-7143
US

IV. Provider business mailing address

PO BOX 910
MADRAS OR
97741-0910
US

V. Phone/Fax

Practice location:
  • Phone: 541-693-5600
  • Fax:
Mailing address:
  • Phone: 541-777-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number999902
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: