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General NPI Number Information
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NPI Number | 1134338460
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Entity Type | Individual
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Provider Name | ROSE EVANS OTR/L MHBC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 9600 VETERANS DR SW BLDG 61
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City | TACOMA
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State | WA
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Zip | 98493-0003
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Country | US
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Telephone | 253-583-1743
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Fax | 253-589-4136
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Provider Business Mailing Address
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Address Line | PO BOX 603
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City | GRAHAM
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State | WA
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Zip | 98338-0603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT00001278
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License Number State | WA
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