=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386126720
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVONNE HELEN EIGHMEY OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2018
-----------------------------------------------------
Last Update Date | 09/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 CYPRESS EDGE DR
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-8453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-586-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 597 CHRISTINA DRIVE
-----------------------------------------------------
City | SAINT AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-387-8822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 16565
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------