Provider Demographics
NPI:1144925090
Name:EVANS, MYRTLE (DRPH, MSPH, OTR/L)
Entity type:Individual
Prefix:DR
First Name:MYRTLE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:DRPH, MSPH, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12530 FAIRWOOD PKWY STE 102 PMB 1079
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6357
Mailing Address - Country:US
Mailing Address - Phone:240-854-8633
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 129-22
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:240-854-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04664225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist