MEDICARE: JOSH EVANS OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	6746	OH

General Provider Information

NPI Number	:	1073970950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSH EVANS OTR/L

Provider Business Mailing Address
First Line	:	40 RYAN LN
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-7006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 RYAN LN
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-7006
Country	:	US
Telephone Number	:	740-352-2502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	01/22/2016

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Directions to “ JOSH EVANS OTR/L” Practice Location

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