Provider Demographics
NPI:1972847424
Name:LEVASSEUR, EVELYN MIRANDA (OTR)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MIRANDA
Last Name:LEVASSEUR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22144 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6925
Mailing Address - Country:US
Mailing Address - Phone:941-488-6733
Mailing Address - Fax:941-484-5610
Practice Address - Street 1:1240 PINEBROOK RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6421
Practice Address - Country:US
Practice Address - Phone:941-488-6733
Practice Address - Fax:941-484-5610
Is Sole Proprietor?:No
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2027225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation