Provider Demographics
NPI:1033717293
Name:RICHARDVILLE, EVA MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:RICHARDVILLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 AIRPORT NORTH OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6703
Mailing Address - Country:US
Mailing Address - Phone:260-417-8399
Mailing Address - Fax:260-489-1481
Practice Address - Street 1:311 AIRPORT NORTH OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6703
Practice Address - Country:US
Practice Address - Phone:260-417-8399
Practice Address - Fax:260-489-1481
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003004A225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility