Provider Demographics
NPI:1134310717
Name:EVANS, SHAROND E (COTA)
Entity Type:Individual
Prefix:
First Name:SHAROND
Middle Name:E
Last Name:EVANS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18250 MARSH LN
Mailing Address - Street 2:APT. 2010
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5700
Mailing Address - Country:US
Mailing Address - Phone:903-926-2830
Mailing Address - Fax:
Practice Address - Street 1:8615 FREEPORT PKWY
Practice Address - Street 2:STE. 225
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2576
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209744224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant