MEDICARE: CATHERINE EVARISTO OTRL, CHT

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	225XH1200X	Hand Occupational Therapist	OT1769	CA

General Provider Information

NPI Number	:	1386649499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE EVARISTO OTRL, CHT

Provider Business Mailing Address
First Line	:	PO BOX 7195
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91359-7195
Country	:	US
Telephone Number	:	818-237-5409
Fax Number	:	818-237-5214

Provider Business Practice Location Address
First Line	:	50 N HILL AVE STE 302
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1903
Country	:	US
Telephone Number	:	818-237-5409
Fax Number	:	818-237-5214

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	02/05/2021

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