MEDICARE: EVELIN EDWARD DENIS

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

General Provider Information

NPI Number	:	1184355463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELIN EDWARD DENIS

Provider Business Mailing Address
First Line	:	3814 W DESERT PARK LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6473
Country	:	US
Telephone Number	:	602-702-9845
Fax Number	:

Provider Business Practice Location Address
First Line	:	3814 W DESERT PARK LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6473
Country	:	US
Telephone Number	:	602-702-9845
Fax Number	:

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

Provider Enumeration Date	:	06/18/2022
Last Update Date	:	06/18/2022

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Directions to “ EVELIN EDWARD DENIS ” Practice Location

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