Provider Demographics
NPI:1912997487
Name:EVANS, AMY ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:EVANS
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 1:1168 CHERRY LANE RD
Mailing Address - Street 2:
Mailing Address - City:GLADE VALLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28627-9281
Mailing Address - Country:US
Mailing Address - Phone:336-467-4357
Mailing Address - Fax:
Practice Address - Street 1:1168 CHERRY LANE RD
Practice Address - Street 2:
Practice Address - City:GLADE VALLEY
Practice Address - State:NC
Practice Address - Zip Code:28627-9281
Practice Address - Country:US
Practice Address - Phone:336-467-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301562Medicaid
NCA9496OtherMEDCOST PREFERRED
NC1175FOtherBCBS/NC
NC173442OtherANTHEM OF VIRGINIA
NC2211795OtherFIRST HEALTH
NC162834OtherHUMANA