Provider Demographics
NPI:1831510692
Name:EVANGELHO, TANYA LORAINE (OTR/L)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LORAINE
Last Name:EVANGELHO
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 1:1755 WITTINGTON PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1927
Mailing Address - Country:US
Mailing Address - Phone:214-442-4445
Mailing Address - Fax:
Practice Address - Street 1:691 MURPHY RD, SUITE 236
Practice Address - Street 2:ACCENT CARE HOME HEALTH
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-414-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-21
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1022861225X00000X
CAOT 4296225X00000X
COOT 0003866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1022861OtherSTATE OF OREGON OCCUPATIONAL THERAPY LICENSING BOARD