Provider Demographics
NPI:1194887018
Name:EVANS, DONNA JEAN (OT)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:EVANS
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 1:21 OSPREY RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-1605
Mailing Address - Country:US
Mailing Address - Phone:304-222-2329
Mailing Address - Fax:304-253-8316
Practice Address - Street 1:21 OSPREY RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-1605
Practice Address - Country:US
Practice Address - Phone:304-222-2329
Practice Address - Fax:304-253-8316
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7501013000Medicaid