Provider Demographics
NPI:1760901540
Name:EVANS, ELLYN MILLER (OTD)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:MILLER
Last Name:EVANS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:ELLYN
Other - Middle Name:SCOTT
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:7132 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1241
Mailing Address - Country:US
Mailing Address - Phone:319-331-8191
Mailing Address - Fax:
Practice Address - Street 1:7132 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1241
Practice Address - Country:US
Practice Address - Phone:319-331-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist