Provider Demographics
NPI:1386274827
Name:EVGENIADIS, MARIA ELENI (OTR/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENI
Last Name:EVGENIADIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CORONET TER
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4290
Mailing Address - Country:US
Mailing Address - Phone:609-234-2985
Mailing Address - Fax:
Practice Address - Street 1:56 MAIN ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-8896
Practice Address - Country:US
Practice Address - Phone:609-388-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00902400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist