Provider Demographics
NPI:1265464002
Name:EVANS, MELINDA GAIL (OT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:GAIL
Last Name:EVANS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MR
Other - First Name:MELINDA
Other - Middle Name:INMAN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 25626
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-5626
Mailing Address - Country:US
Mailing Address - Phone:336-768-1270
Mailing Address - Fax:336-765-6375
Practice Address - Street 1:170 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-768-1270
Practice Address - Fax:336-765-6375
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC552225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2510810Medicare UPIN