Provider Demographics
NPI:1548356025
Name:EVANS, ROSLYN B (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:B
Last Name:EVANS
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 37TH STREET
Mailing Address - Street 2:SUITE E-110
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-562-6401
Mailing Address - Fax:772-562-6011
Practice Address - Street 1:787 37TH STREET
Practice Address - Street 2:SUITE E-110
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-562-6401
Practice Address - Fax:772-562-6011
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 79225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4461Medicare PIN