Provider Demographics
NPI:1962370817
Name:EVERSOLE, CRISTINA EVETTE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:EVETTE
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 GRAY FOX LN
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-8790
Mailing Address - Country:US
Mailing Address - Phone:928-388-8820
Mailing Address - Fax:
Practice Address - Street 1:3448 GRAY FOX LN
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-8790
Practice Address - Country:US
Practice Address - Phone:928-388-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125564225X00000X
MI25169070628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist