Provider Demographics
NPI:1952634867
Name:STRECKERT, EVANA MARIE
Entity Type:Individual
Prefix:MS
First Name:EVANA
Middle Name:MARIE
Last Name:STRECKERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 1/2 SHAFTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4663
Mailing Address - Country:US
Mailing Address - Phone:325-315-6072
Mailing Address - Fax:
Practice Address - Street 1:1410 1/2 SHAFTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-4663
Practice Address - Country:US
Practice Address - Phone:325-315-6072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000862224Z00000X
TX209924224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant