Provider Demographics
NPI:1063751287
Name:EVANS, CYNTHIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 CR 8
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:IN
Mailing Address - Zip Code:46742
Mailing Address - Country:US
Mailing Address - Phone:260-316-8825
Mailing Address - Fax:
Practice Address - Street 1:6155 COUNTY ROAD 8
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:IN
Practice Address - Zip Code:46742-9727
Practice Address - Country:US
Practice Address - Phone:260-316-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002205A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant