Provider Demographics
NPI:1578726725
Name:EVANS, HORACE WAYNE (OT)
Entity Type:Individual
Prefix:
First Name:HORACE
Middle Name:WAYNE
Last Name:EVANS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8481 OLD BOONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8885
Mailing Address - Country:US
Mailing Address - Phone:859-527-0322
Mailing Address - Fax:
Practice Address - Street 1:200 GLENWAY RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8991
Practice Address - Country:US
Practice Address - Phone:859-744-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2279225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist