Provider Demographics
NPI:1205554789
Name:JASPER, EVELYN MCCRAE (OTR/L)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MCCRAE
Last Name:JASPER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:MCCRAE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1612 EBENEZER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3862
Mailing Address - Country:US
Mailing Address - Phone:803-329-9500
Mailing Address - Fax:803-228-0101
Practice Address - Street 1:1612 EBENEZER RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3862
Practice Address - Country:US
Practice Address - Phone:803-329-9500
Practice Address - Fax:803-228-0101
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist