Provider Demographics
NPI:1144507914
Name:ANDAMO, EVELYN MACHAN (OT)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MACHAN
Last Name:ANDAMO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9761 OLYMPIC DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4846
Mailing Address - Country:US
Mailing Address - Phone:714-883-4046
Mailing Address - Fax:714-963-5375
Practice Address - Street 1:11391 ACACIA PKWY
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5310
Practice Address - Country:US
Practice Address - Phone:714-530-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 665225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist