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NPI Code Detail

MEDICARE: MR. MARK EVANDER MCDAVID OTR/L

MEDICARE: MR. MARK EVANDER MCDAVID 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
1225X00000XOccupational TherapistKY-R2948KY

General Provider Information

NPI Number : 1669647731
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK EVANDER MCDAVID OTR/L
Provider Business Mailing Address
First Line : 1 PARK WEST CIR
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-5551
Country : US
Telephone Number : 804-855-4086
Fax Number :
Provider Business Practice Location Address
First Line : 1 PARK WEST CIR
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-5551
Country : US
Telephone Number : 804-855-4086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2008
Last Update Date : 08/07/2009

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