Provider Demographics
NPI:1477284685
Name:LUNDQUIST, EVAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:M
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 1:14396 POLO CLUB DR BLDG 9
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-8922
Mailing Address - Country:US
Mailing Address - Phone:419-612-2873
Mailing Address - Fax:
Practice Address - Street 1:100 BROOKMONT RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-9207
Practice Address - Country:US
Practice Address - Phone:330-666-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-19
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist