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NPI Code Detail

MEDICARE: COLLEEN EVANS

MEDICARE: COLLEEN EVANS
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 Therapist114935TX

General Provider Information

NPI Number : 1740685270
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN EVANS
Provider Business Mailing Address
First Line : 1000 S LORRAINE RD APT 204
Second Line :
City : WHEATON
State : IL
Zip : 60189-6958
Country : US
Telephone Number : 331-240-0722
Fax Number :
Provider Business Practice Location Address
First Line : 5756 N KNOLL
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78240-2238
Country : US
Telephone Number : 210-321-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2014
Last Update Date : 10/27/2014

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Directions to “ COLLEEN EVANS ” Practice Location

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