Provider Demographics
NPI:1609066042
Name:EVANS, LINDA L (OTR)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:LEE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:HILBERT
Mailing Address - State:WI
Mailing Address - Zip Code:54129-0004
Mailing Address - Country:US
Mailing Address - Phone:920-853-7123
Mailing Address - Fax:
Practice Address - Street 1:308 W MAIN
Practice Address - Street 2:
Practice Address - City:HILBERT
Practice Address - State:WI
Practice Address - Zip Code:54129
Practice Address - Country:US
Practice Address - Phone:920-853-3444
Practice Address - Fax:920-853-3550
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2411 026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40841400Medicaid