Provider Demographics
NPI:1013453703
Name:EVIDENTE, ANN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:EVIDENTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 ELGERS ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8333
Mailing Address - Country:US
Mailing Address - Phone:562-682-1214
Mailing Address - Fax:
Practice Address - Street 1:12400 ELGERS ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8333
Practice Address - Country:US
Practice Address - Phone:562-682-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist