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General NPI Number Information
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NPI Number | 1164898664
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Entity Type | Individual
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Provider Name | EVAN OCONNELL SCALL
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 111 EDGARTOWN RD
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City | OAK BLUFFS
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State | MA
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Zip | 02557
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Country | US
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Telephone | 401-339-6501
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Fax |
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Provider Business Mailing Address
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Address Line | 18 SADDLE CLUB RD
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City | EDGARTOWN
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State | MA
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Zip | 02539-6547
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Country | US
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Telephone | 401-339-6501
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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