Provider Demographics
NPI:1386649499
Name:EVARISTO, CATHERINE (OTRL, CHT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:EVARISTO
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7195
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7195
Mailing Address - Country:US
Mailing Address - Phone:818-237-5409
Mailing Address - Fax:818-237-5214
Practice Address - Street 1:50 N HILL AVE STE 302
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1903
Practice Address - Country:US
Practice Address - Phone:818-237-5409
Practice Address - Fax:818-237-5214
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1769225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT1769FMedicare ID - Type Unspecified
CAWOT1769EMedicare ID - Type Unspecified