Provider Demographics
NPI:1972537165
Name:REDA, EVELYN (MED, OTR)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:REDA
Suffix:
Gender:F
Credentials:MED, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HITCHING POST RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1155
Mailing Address - Country:US
Mailing Address - Phone:413-549-1391
Mailing Address - Fax:
Practice Address - Street 1:150 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2232
Practice Address - Country:US
Practice Address - Phone:413-256-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2203 OT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOT0056OtherBC/BS OF MA
MA0390291Medicaid
MAY68050Medicare ID - Type Unspecified