MEDICARE: EVAN FAKHREDDINE 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

General Provider Information

NPI Number	:	1265933584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN FAKHREDDINE OTR/L

Provider Business Mailing Address
First Line	:	10472 WELLINGTON MANOR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4514
Country	:	US
Telephone Number	:	301-385-1784
Fax Number	:

Provider Business Practice Location Address
First Line	:	10472 WELLINGTON MANOR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4514
Country	:	US
Telephone Number	:	301-385-1784
Fax Number	:

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

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	05/19/2023

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Directions to “ EVAN FAKHREDDINE OTR/L” Practice Location

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